The 5 W’s of Marketplace Health Insurance

Knowledge based on the 5W’s of marketplace health insurance should serve as a reliable foundation for understanding and choosing coverage which meets the qualifications of the Obama health plan. The 5W’s stand for what, why, who, when and where.

What is marketplace health insurance?

Marketplace health insurance is coverage obtained through one of the governmental health insurance exchanges which provides a minimum standard of benefits known as the essential health benefits as specified by the Patient Protection and Affordable Care Act, referred to by many as ObamaCare. The plans are sold by private insurance companies and generally are HMO and PPO plans. Each plan has a metal designation of bronze, silver, gold, or platinum, depending upon services covered and the actuarial value of the plan. Marketplace health insurance plans cannot deny coverage or charge a higher premium for pre-existing illnesses. They cover some preventive care services.

Why purchase marketplace insurance?

The answer to this question rests in Affordable-Care-Act subsidies, also known as premium tax credits, and whether or not you qualify. Eligibility for Affordable-Care-Act subsidies is based on annual household income provided that income is at least 133% but less than 400% of the federal poverty level beginning in 2014. The premium tax credit calculation is based on a provision of the Affordable Care Act that no American should spend more than 9.5% of household income on medical insurance premiums. Given that provision, Obama-health-plan insurance could be purchased outside of the marketplace from a broker or insurance company. The dollar amount of the annual premium in excess of that allowed under the Affordable Care Act for a given income level could then be claimed as an end-of-the-year deduction during income tax filing. If the coverage is obtained through a health insurance marketplace however, the credit can be applied to the monthly premium of any Obama-healthcare-plan selected, resulting in a lowering of the monthly premium of the plan.

Who is eligible to purchase marketplace insurance?

Marketplace health insurance through the federal or one of the state insurance exchanges is for individuals and families less than 65 years of age or small businesses with 50 or fewer employees. Eligibility includes United States citizenship and/or legal residence. Additionally, one must not be incarcerated.

When does having medical insurance become mandatory, when can I enroll, and when does the penalty for not having insurance take effect?

January 1, 2014 is the date that most United States citizens and legal residents must have medical insurance coverage or suffer a tax penalty of $95 per adult, $47 per child, or 1% of the annual household income (whichever is greater) if one is uninsured as of January 1, 2014 and coverage has not been obtained by February 15, 2014. Open enrollment will extend until the end of March 2014. If you have a qualifying life-changing event however, such as marriage, relocation to another state, loss of job-based insurance or expiration of COBRA coverage, marketplace insurance can be obtained as an exception at times after the closure of the open-enrollment season in March 2014 and in subsequent years.

Where can I purchase marketplace insurance?

If you reside in a state whose health exchanges operated by the federal government you will need to purchase through that exchange. Alternatively, marketplace health insurance can be purchased through a private health insurance exchange if it has contractual authority granted by the federal government to enroll Obama health plan applicants. As of December 1, 2013, residents of the District of Columbia and states with state operated insurance exchanges must obtain marketplace medical insurance through the state exchanges. Those states are Those states are California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington.

Insurance Company Complaints Who Are The Top 10 Companies With The Least Number Of Complaints

The New York State Department of Insurance (DOI) just released the 2008 Annual Ranking of Automobile Insurance Complaints. The report has been issued to help consumers find the automobile insurer that best meets their needs. You can use this report to compare the ranking of the insurance company you are doing business with now, or check another company you may be considering.

This report analyzed data collected from 2006 and 2007. It only ranks companies doing business in the State of New York. However, as New York is a heavily populated state, with both big urban centers and big suburban areas, the report can be considered a good representation of insurance company performance nationwide.

How The Ranking Works

The insurance companies are ranked on a complaint ratio. The ratio is calculated by the number of complaints upheld against companies as a percentage of their total private passenger auto business.

Insurers with the fewest upheld complaints per million dollars of premiums are shown at the top of the list. The companies with the highest ratio of complaints are ranked at the bottom.

Other Information to Consider

The ranking of an insurance company is important, but it is only one characteristic that consumers should weigh when considering doing business with an insurance company. Others are:

Referrals from friends, relatives, neighbors or co-workers about the experiences they had with their insurance companies
Price of the premium versus perceived value
Search the Internet for other ideas
Check your states DOI website, which may contain valuable consumer information about companies doing business in your state.

What The Ranking Does and Does Not Contain

Private passenger insurance is the only type evaluated.
It only includes the complaints referred by consumers to the DOI. It does not include complaints made directly to the insurance companies.
Complaints are upheld when the DOI agrees with a consumer that an insurance company made an inappropriate decision.
Information from prior years is included in the tables so consumers can see if the company has improved or gotten worse.
All companies with at least $10 million in premium in 2006 and 2007 are included in the ranking. Insurers with less than $10 million were included if they had 10 or more complaints against them.

Top Three Most Common Complaints

1.Monetary settlements settlement amount is too low.
2.Policy terminations
3.Promptness of insurance payments

2007 Auto Complaint Listing (ranked lowest number at top, higher as you go down)

1.Mercury General Group
2.American Express, Amex Assurance, IDS Property Casualty
3.Eveready Insurance Co.
4.Electric Insurance Group
5.Amica Mutual
6.Preferred Mutual Insurance Co.
7.United Services Automobile Assurance Group (USAA)
9.Utica Mutual
10.State Farm
11.Central Services Group, Central Insurance Group, NY Central Mutual Fire Ins.
12.Main Street America Group, National Grange Mutual
14.Liberty Mutual
15.Kingsway Insurance Group, Lincoln General Ins.
16.Response Insurance Group
17.Nationwide Insurance
18.American Modern Ins. Group, American Family Home Ins.
19.St. Paul Travelers
20.Unitrin Group, Kemper
21.Erie Insurance Group
22.Berkshire Hathaway Insurance, GEICO
23.Allstate Insurance
24.The Hartford Insurance Group
25.Hanover Insurance, Citizens Ins., Allmerica Financial Alliance
26.Metropolitan Group
27.American National Financial Group
28.Allianz Insurance Group
29.GMAC, Integon, MIC P&C, National General Ins. Co.
30.Zurich Ins.Group, Foremost, Maryland Casualty
31.Hannover RE Group, Clarendon National
32.State Wide Insurance
33.White Mountains Group, OneBeacon, Esurance, Auto One Ins.
34.Countrywide Insurance
35.Safeco Insurance Group
36.American International Group (AIG)
37.Tri-State Consumer Ins. Group
38.Interboro Mutual
39.Infinity Property & Casualty
40.Long Island Insurance


If your auto insurance provider is not shown on this list, it could be that they dont sell insurance in New York. Or, it could be that their number of complaints is worse than the company in the #40 position!!

Think about this statement, my friends.

The only thing that truly matters about your auto insurance is what happens when you submit a claim. Claims are about KEEPING PROMISES. When the insurance companies dont keep their promises, the complaints pile up!

So, why would you EVER consider doing business with any insurance company LOWER than NUMBER 10 on the list?

If you are one of the unfortunate people who experience an automobile loss of any kind, you’ll need to know how to handle your insurance claim so that you maximize your recovery. You will need to know how to take control of your insurance claim, and add hundreds or even thousands more dollars to your claim settlement. For more information, check out the website shown below in the Resource Box.

Is Health Insurance Exchange Navigator Program Attracting Criminals

The health insurance exchange navigator program has come to be seen as a life savior for the Obama administration after the fiasco. With a crumbling website and all hands dedicated to keeping it from falling, the health insurance exchange navigators are making sure that people are able to go through the enrollment process. Some navigators are also utilizing the skills gained through the exchange navigator program and helping people with paper applications, especially when the online applications fail. In a nutshell, the millions of dollars given as grants to these navigators are being put to good use in every state.

However, there is a downside to this seemingly angelic attempt by organizations to help people enroll on the marketplaces. In the last couple of weeks, it has come to the notice of the government that several criminals and shady characters are making use of the exchange navigator program to make money. There have been several cases that have demonstrated hidden agenda of working navigators, including a suggestion for applicants to lie on their profile so that they can save a few dollars on premiums. For instance, in an incident in Dallas, three navigators were fired when they were caught on video trying to advise a senior citizen to not to mention tobacco use on his application as it might lower his chances of getting subsidy and low premiums.

Another incident of New York shows the loopholes in the health insurance exchange navigator program, and how a car service company, a cupcake bakery, and a spa saloon were listed as health insurance exchange navigators. While it is not clear whether this was done intentionally, it still exposes the gaps that exist in the whole selection process.

In the light of these events, several other states have become wary of criminals and illegitimate people making use of the exchange navigator program for their hidden agendas. Florida, for instance, has made sure that since these navigators have access to SSN and tax information of applicants who utilize their assistance, all such navigators need to be checked for a criminal history, including a fingerprinting check and criminal background check. Several other states are thinking to follow suit.

However, while these measures show the administration’s vigilance in selecting the right candidates for a job that puts them closer to sensitive information, such actions could cause a severe side effect which the government cannot sustain at the moment – obstruction of navigator function. Several navigators have complained that after receiving the federal grant, they have had to go through extensive interviews again and again for verification of their credibility. While these navigators do not find this to be extremely wrong, they cite wastage of time that could be used for enrolling people, as a major concern.

Child Support in New York

Any couple that goes through a divorce has to deal with many issues, but those that have children usually go through even more acrimony when dealing with custody and support for their children. Child support is financial support provided by the noncustodial parent. Child support includes, cash payments (based on the parent’s income and the needs of the child), health insurance for the child, payments for child care, and payments for reasonable health care costs that are not covered by health insurance. Family Court determines the amount of child support the noncustodial parent will pay. Under New York State law, parents are responsible for supporting their child until the child is 21 years old.

There are guidelines in which the court uses to determine the amount of child support that is owed to the custodial parent, based on the noncustodial parent’s adjusted gross income and on the number of children involved. The court first determines the noncustodial parent’s gross income. The court then multiplies the adjusted gross income by the standard guideline percentage for the number of children. These percentages are as follows:
17% for one child
25% for two children
29% for three children
31% for four children
at least 35% for five or more children.
Then the noncustodial parent’s share of child care, medical, and educational expenses is added to the income percentage amount. The combined amount, percentage of income plus share of expenses, is the basic child support amount.

For incomes over $130,000, the court determines whether or not to use the percentage guidelines and may consider other factors in setting the full child support payment.

The main problem that many noncustodial parents have an issue with is that many fill out long and tedious expense forms and when it comes time to determine the monthly the courts do not take into consideration the expenses of the noncustodial parent. If you cannot pay your child support you can file a “petition for modification” with the court that issued the support order. Only the court can change what you owe. Just because you think you cannot pay, do not stop paying. Continue to pay what you can while you wait for the court to make a decision. You should know that the court will only change the amount of support you need to pay if there has been a substantial change in your ability to pay.

Dealing with child support and child custody it can be very emotional, remember that in the end you want what is best for your children.