health insurance

The Affordable Care Act, more commonly known as Obamacare will be making headlines again soon with the open enrollment period opening on November 1, 2016. Grant is joined by Kristy Whipple, a Personal Lines Account Manager with CLH and new Account Executive, John Sundling to discuss open enrollment and how it might effect you.

Below is a transcript of the episode, modified for your reading pleasure. For more information on the topics discussed in the episode, see the links at the bottom of this post.

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Grant FINLEY:  Hello and welcome to Your Insurance Connection Podcast.  I'm your host, Grant Finley and joining me today is Kristy Whipple, a Certified Insurance Service Representative and one of CLH's personal lines account managers and John Sundling, CLH's newest Account Executive with a background in life and health.  Guys, thanks for joining the program today.


John SUNDLING: Thank you.


Kristy WHIPPLE:  Thanks for having me, Grant.  I appreciate it.


FINLEY:  Absolutely, so what we want to talk about today is ACA but more pointedly open enrollment.  That's going to be starting on November 1st so we figured we'd kind of get a head start on this and maybe answer any questions that folks might have ahead of that November 1 deadline.  So, let's just kind of throw it out there.  Obviously, ACA has been in the news the last few years, good, bad or indifferent, but maybe you don't know a lot about it.  So, if I don't know what this open enrollment is - I've never used it before, but maybe I need to now, what do I need to know?  What is it exactly?


SUNDLING:  Well, the ACA stands for the Affordable Care Act.  It was set in law in 2010, it's hard to believe it's already six years ago, but otherwise known as Obamacare.  So, as you mentioned, the open enrollment starts November 1st and that will go through all the way until January 31st, 2017.  We're right around the corner from it.


FINLEY:  And, what exactly is open enrollment, Kristy?  What does that mean?


WHIPPLE:  So, what it means - it's the time period that anyone can get a quote for and apply for coverage for individual healthcare or group healthcare insurance.  You can start getting a quote or applying for coverage on November 1st and then if you do so prior to December 15, so in other words if you do apply for a policy by December 15th, you'll have a January 1st, 2017 effective date.  Anyone who enrolls after December 15th up until January 31st, 2017 will have a February 1st, 2017 effective date.  


FINLEY:  So, can anybody be turned down for this coverage or is anybody who applies going to get it?  Isn't that the point of Obamacare?


SUNDLING:  Well, yeah, the ACA pretty much has brought the barriers down on anybody not being able to get affordable healthcare.  So, that law has actually prevented some of the things that had gone on prior to that so, it's not going to be a problem for pretty much anybody.


FINLEY:  And then, it's law.  You have to have healthcare now, correct?


WHIPPLE:  Yeah, it's mandatory, so if people who do not enroll or apply for coverage during the time of the open enrollment and they don't have coverage during any other month of the year then for that year they will pay a penalty on their taxes for not having been enrolled in a policy.


FINLEY:  So, if i'm working for a company and I've got health insurance through who I work for, does this effect me in any way?


WHIPPLE:  No, when you have health insurance and whether it's your individual or your group coverage, with your W2's and tax forms at the beginning of the year you'll also get a form that indicates that you've had health insurance and so therefore when you're filing your taxes you refer to that form and then you won't be penalized.


SUNDLING:  And also too, going back to the penalty, 2016 year penalty was 2% and that is then going up another half percent up to 2.5% for 2017.  Every year it gets a little bit harder on the pocket book if you fail to enroll in a plan.  


FINLEY:  So, can you only enroll in this two [three] month window, or are there other times or other reasons you might be able to enroll?


WHIPPLE:  Right, there are times outside of open enrollment when you can apply for coverage but you have to have a qualifying event.  In other words, there has to have been a marriage, a divorce, a death, a birth, an adoption, or an involuntary loss of coverage such as you lost your job or your COBRA ended and then at that time you can get a policy, but you would have to provide documentation stating the qualifying event in order to be able to get the coverage.


SUNDLING:  Yeah, I think the government is getting a little bit more firm on that proof that Kristy was just speaking of.  Back in 2014 and 2015 there were a little lax on that and I did see they were going to be a little bit more demanding on the proof of these qualifying events.


WHIPPLE:  Anthem, which is a company that we write the most with, they're pretty strict on it and they have a very specific guidelines and if the proof of coverage is not submitted or it's not correct, they close the application and you have to start all over again, so you have to be very sure that when you start you have all your documentation, exactly what they want to see.




FINLEY:  Would this also apply to contract workers or self-employed individuals?  Would this be the route that they need to go if they wanted to have health insurance?


WHIPPLE:  Yeah, a self-employed individual would have to get an individual policy if they don't have any employees.  People who have - like if Chuck and Kathy here needed to look for insurance they would go on the SHOP Marketplace, which is the market place for small business with 50 or fewer full-time employees.  But, anybody who is just - works for themselves or self-employed, they would just get their own individual policy each.


FINLEY:  So, a small business - and that's a can of worms we could really dive into, but if you own a small business you can get coverage for your employees on the Marketplace?


WHIPPLE:  Yes, under SHOP.


SUNDLING: Correct.


FINLEY:  Alright, so say I'm a person who just lost a job or whatever the scenario may be.  I need to get this coverage and now that enrollment is about to open, what do I do?  Do I contact an Anthem, you mentioned Anthem, do I go Blue Cross, do I come to CLH and say, "Guys, help me out?"  What's the best course of action?


SUNDLING:  I would say come to CLH.


WHIPPLE:  (Laughter) Definitely, you'd want to come to CLH!


FINLEY:  But, you could just come talk to your local insurance agent?




WHIPPLE:  Independent Agent or you could contact a direct writer.


SUNDLING:  Yeah, it's not the most exciting topic, but very important obviously.  So, contacting an agency like ours would be very beneficial and very recommended, obviously.


WHIPPLE:  It's kind of confusing for a lot of people because there's such a variety of deductibles you can have in the policy and probably a lot of people have heard of the different medical tiers like Platinum, Gold, Silver, Bronze, on Exchange, off Exchange.  There's all kinds of different deductibles and you can choose different deductibles, you can choose whether or not you have co-pays with your primary care doctor or with a specialist.  You can choose if you're prescription drugs are even covered at all or if they're subject to deductible or if you just have co-pays at the pharmacy.  There are a lot of variables so if you have someone to help you walk through that and figure out what's best for you, that's very helpful and that will take a lot of stress out of your -


SUNDLING: I would have to definitely agree with that!


WHIPPLE: (Laughter)


FINLEY:  So, I'm curious whether or not income or dependence is going to impact a person's eligibility?


WHIPPLE:  It absolutely does and one of the options for applying for an individual policy is if you would want to check and see if you're eligible for a subsidy.  So, in addition to inputting your name, date of birth, and whether or not you smoke and everybody - your dependents who live in the household with you and then the final question is what is the annual household income.  Click on submit and then the system will let you know the amount of the subsidy that you would qualify for and then that is automatically included in the quotes, so when you're looking at all of the different options your subsidy would be included in each quote.  So, for example, if you're looking at the first option and it's around a $6,000 deductible and it's like 50% co-insurance - if that premium is $400 a month and the subsidy is $200, then it's going to tell you that the amount that you would pay is $200 a month.  


SUNDLING:  So more dependents, more subsidies, obviously.


WHIPPLE:  Right.  It never hurts to check to see if you're eligible for a subsidy.  So many people say, "Oh, I'm not eligible," or they think that they would never be able to get one but you'd be surprised at the level of income and then when you include dependents in there as well, you'd be surprised at how much you can earn and still get a subsidy.  




WHIPPLE:  It's very helpful and anybody who takes the policy with the subsidy, that's referred to as the "On Exchange" policy, so then, if I were quoting that for you I would input the initial information, get the quote started and then any "On Exchange" policies have to be applied for through the Health Insurance Marketplace.  So then, the application would be transferred to the insured to complete.


SUNDLING:  Correct, right.  And in some instances too, where families are going to have an income level of let's say $35-45,000, but have three kids, those subsidies may be a situation where those children will then be basically be transferred to a CHIP policy or Medicaid and then the children will be on Medicaid and Mom and Dad or the parents will then be on a traditional ACA plan.


FINLEY:  Well, any closing thoughts out of either one of you?


SUNDLING:  Well, it doesn't take too terribly long to go through the process of putting something together, putting some options together and then of course actually enrolling.  You can usually do it in 20-25 minutes and then obviously a little bit longer if you've got several family members as well.  It doesn't take a long time and we can definitely put something together that will provide some options for you.


WHIPPLE:  The only information that's needed to do a quote is everybody's name, date of birth, and whether or not they smoke, your zip code and somebody's - whoever's going to pay for it, their email address.  That's really it.  It's a pretty simple process to start.  


SUNDLING:  And maybe if there were any medications and so forth that we would need to look into.

WHIPPLE:  Yeah, that's a little bit more specific but also helpful because you want to be able to pick a program that's going to pay for the medications that you're on, plus be sure to make sure your doctors are covered.




WHIPPLE:  Not all doctors accept all claims.


SUNDLING:  That's true.


WHIPPLE:  Or hospital medical assistants, they don't accept all claims.


FINLEY:  And we could help steer them in the right direction?


WHIPPLE:  Oh, absolutely, yeah.


SUNDLING:  Sure, sure.


WHIPPLE:  Because we have access through our quoting platforms to look up and see, does this doctor accept this plan or does this hospital or is this drug covered and how many co-pays will my plan cover.


FINLEY: Perfect.  Well, not only is it required by law now, it sounds like it's just plain smart.  So, certainly encourage everyone to make sure they're covered and if they need to come contact us in order to do so, we encourage that as well.  But, I think that is going to take care of it for this episode.  Guys, I want to thank you again for taking some time to join us today.


WHIPPLE:  Perfect.  Thank you very much, Grant.


SUNDLING:  Thank you. 


Your Insurance Connection podcast can be heard on iTunes and Stitcher or by visiting If you like what you’ve heard you can support this podcast by rating and/or sharing it on your social platforms. CLH Insurance is a “Trusted Choice”, independent agency servicing Missouri, Kansas and Illinois. For more information on CLH Insurance, visit or call 636.391.0700 to speak with an agent. Until we connect again, thanks for listening. 

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Show Notes - Where you can learn more about the people and ideas discussed in this episode. 

ACA - Affordable Care Act
COBRAConsolidated Omnibus Budget Reconciliation Act
SHOP Marketplace - Small Business Health Options Program
On Exchange vs Off Exchange
Health Insurance Marketplace
CHIP - Childrens Health Insurance Program
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