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The American Rescue Plan and your Colorado health insurance



American Rescue Plan increased subsidy calculations

You may have seen headlines recently about how the American Rescue Plan (HR1319) makes health insurance more affordable for people who buy their own coverage. As always, you can reach out to me if you have questions about your specific circumstances. But I wanted to summarize some general information:

  • Section 9662 of the American Rescue Plan: If you would have had to pay back excess premium tax credits from 2020, you no longer need to do so. If you’ve already filed your 2020 tax return and repaid some or all of your premium tax credit from 2020, the IRS is advising that you hang tight and wait for more information (ie, they say people should not file an amended return at this point in order to recoup that money). Note that you can still get additional premium tax credits while you file your taxes, if the amount that was paid on your behalf last year was too small. But if it was too big, you don’t have to repay any of it. This is a one-time repayment holiday, for 2020 only.
  • Section 9661 of the American Rescue Plan makes coverage more affordable this year and next year. I’ll cover some examples of this in more detail below. But in general, people with income over 400% of the poverty level can qualify for premium tax credits if the benchmark plan costs more than 8.5% of their income. And people with income below that level can qualify for larger premium tax credits than they currently receive. People with fairly low income (up to $25,860 for a household of two, for example) can qualify for a Silver plan with $0 premium and robust cost-sharing reductions. 
  • Section 9663 of the American Rescue Plan allows people receiving unemployment compensation in 2021 to enroll in a $0 premium Silver plan with robust cost-sharing reductions. You have to be otherwise eligible for premium subsidies, which means you can’t be eligible for Medicaid or an employer-sponsored plan that’s considered affordable. But otherwise, regardless of how long your unemployment benefits last in 2021, and regardless of how much you actually earn, you’ll qualify for premium subsidies as if your income is just over the lower threshold for premium subsidy eligibility. In 2021, that means you pay nothing for the benchmark Silver plan, and you get full cost-sharing reductions, which make the plan’s benefits more robust than a normal Platinum plan.
    Connect for Health Colorado interprets the statute to include dependents. So even if you only have a dependent in the household who has received unemployment benefits, the entire household will qualify for the $0 premium Silver plan with maximum cost-sharing reductions.
  • Connect for Health Colorado is currently running a COVID-related special enrollment period for uninsured residents, which has been extended through August 15, 2021. Note that “uninsured” includes people who have non-insurance coverage options, such as health care sharing ministry plans or direct primary care plans.
    UPDATE: Starting April 15th, Connect for Health Colorado will actually treat this SEP like an Open Enrollment period. So current enrollees may switch plans with no metal level restrictions until August 15th. Coverage begins the first day of the month following enrollment. If you’re enrolled in a non-ACA plan because an ACA-compliant plan was previously too expensive or you would just like to switch to a better plan, you may find that coverage is now much more affordable than it was in prior years. Consumers will be able to switch to any plans they prefer between April 15th and August 15th. If you’re not already enrolled through Connect for Health Colorado, you’ll be able to quote and enroll for the expanded subsidies starting April 15th for a May 1 effective date.
  • Connect for Health Colorado is working closely with the Colorado Division of Insurance to sort out the details for people who already have coverage and need to update their information in order to take advantage of the new premium subsidies. Folks who are already enrolled through Connect for Health Colorado will be able to re-submit their financial eligibility to take advantage of the expanded subsidies starting May 15th for a June 1 effective date.
  • If you’re already enrolled in a plan through Connect for Health Colorado and you don’t want to make a plan change or update your financial information, you’ll be able to claim the additional premium tax credits (if applicable for your situation) when you file your 2021 tax return. But if you’re enrolled in a plan outside the marketplace, you’ll need to switch to a plan through Connect for Health Colorado in order to take advantage of the new premium tax credits, either upfront in realtime, or on your tax return. Connect for Health Colorado is working on the details in terms of when people who already have coverage might be able to make changes.

Examples of savings

An example helps to illustrate the American Rescue Plan’s premium assistance. Let’s consider a 50-year-old Denver resident (zip code 80206), and see how their premiums would change at various income levels. Note that Connect for Health Colorado’s subsidy calculator does not yet have the new ARP subsidy amounts built-in (they’ve planned on their website having that functionality on April 15th), so we’ve calculated these numbers manually; here’s how the math works. Kaiser Family Foundation also has a calculator available:

Income = $18,000

  • Current subsidy amount = $412/month
  • Current benchmark premium = $54/month (plan includes cost-sharing reductions; has a $200 deductible and $2,000 maximum out-of-pocket)
  • Current lowest-cost plan premium = $0/month (numerous plans, all with $8,550 maximum out-of-pocket limits)
  • Subsidy amount under American Rescue Plan = $466/month
  • Benchmark premium under American Rescue Plan = $0/month

Income = $40,000

  • Current subsidy amount = $139/month
  • Current benchmark premium = $327/month (plan has a $3,700 deductible and $8,150 maximum out-of-pocket)
  • Current lowest-cost plan premium = $223/month (plan has an $8,550 deductible and maximum out-of-pocket)
  • Subsidy amount under American Rescue Plan = $255/month
  • Benchmark premium under American Rescue Plan = $211/month

Income = $55,000

  • Current subsidy = $0 (income above 400% of the poverty level, so no subsidies without the ARP)
  • Current benchmark premium = $466/month (plan has a $3,700 deductible and $8,150 maximum out-of-pocket)
  • Current lowest-cost plan premium = $362/month (plan has an $8,550 deductible and maximum out-of-pocket)
  • Subsidy amount under American Rescue Plan = $76/month
  • Benchmark premium under American Rescue Plan = $390/month (8.5% of income)

These amounts are specific to a 50-year-old living in Denver. If you’re older or living in one of the areas of the state where coverage is more expensive, your additional subsidy amounts could be larger — significantly so in some cases. But if you’re younger and in an area of the state where premiums are less expensive, the additional subsidy amounts may be smaller. Most enrollees, however, will see more affordable coverage as a result of this new legislation.

#American #Rescue #Plan #Colorado #health #insurance

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What is the Medicare Part D coverage gap? REMEDIGAP





In the world of Medicare, there exists a peculiar term called the “donut hole.” No, we are not referring to the sweet, deep-fried confectionery that tempts our taste buds. Instead, the doughnut hole refers to a unique coverage gap in the Medicare Part D drug plan (Medicare’s prescription drug program). Understanding this concept is essential for those relying on Medicare for their healthcare needs. That’s because it directly impacts out-of-pocket expenses for prescription medications.

Medicare Part D Donut Hole

The donut hole is a phase within your Medicare Part DD prescription drug coverage (It is not related to medications that are covered under your Medicare Part B). It is where beneficiaries must bear a more significant portion of their prescription costs. It is a point in your drug coverage, marked by a specific dollar amount. Once you spend a certain amount on medications and reach a certain threshold, beneficiaries enter the “donut-hole”. This is where they are responsible for a higher percentage of costs until they reach the next threshold.

Though the concept may appear confusing at first. Being aware of it is paramount for beneficiaries to effectively manage their healthcare costs. It will also help them make informed decisions regarding drug coverage. Let’s dive a little deeper into the specifics and how it affects beneficiaries.

When do you enter the donut hole?

The donut hole begins once the total amount spent on covered drugs by both the person and their insurance plan reaches a certain threshold. At this point, the individual enters the initial coverage stage. In other words, you’re in the donut hole. This is where you’re responsible for paying 25% of the cost for brand-name drugs and 25% of the cost for generic drugs (the drug manufacturer pays 75%).

It is important to note that the cost that applies towards reaching the threshold includes the following: The amount paid by the person and any drug manufacturer discounts received for brand-name drugs.

Once the individual reaches the catastrophic coverage threshold, their out-of-pocket costs decrease significantly. It is crucial for individuals enrolled in Medicare drug plans to be aware of this and plan their medication expenses accordingly.

When do you get out of the donut hole?

Once you exceed the threshold of cost, you will be out of the “donut-hole” and you’ll enter the catastrophic coverage phase. When closing the donut-hole, it’s important to note that not all expenses count towards reaching the threshold.

For example, Part D premiums don’t help you with this coverage phase. Payments made by your drug plan and manufacturer discounts are among the costs that don’t contribute to reaching the out-of-pocket limit.

How to avoid the Medicare donut hole?

Navigating the complex landscape of Medicare can be overwhelming. However, there are strategies to help minimize the impact. One approach is to carefully select a Medicare Part D coverage plan and review its costs. Comparing different Medicare plans and understanding their formulary can allow beneficiaries to determine which plan provides the most comprehensive Medicare Part D coverage for their specific medication needs.

Another way to avoid the donut-hole is to take advantage of cost-saving initiatives, such as generic drugs or mail-order pharmacy services. By opting for lower-cost alternatives and prescription delivery services, beneficiaries can stretch their medication budget. This can potentially delay reaching the threshold. It is also crucial for individuals to monitor their medication usage throughout the year and be aware of their total costs. Tracking expenses and consulting with a Medicare expert can ensure beneficiaries stay informed. It helps to take these necessary steps to avoid falling into the Medicare donut-hole.

When is the Medicare Donut Hole Closed?

In the past, beneficiaries had to cover the full cost of their medications while in the gap. However, with the passing of the Affordable Care Act in 2010, a plan was put into motion to close this gap in coverage completely. This plan aims to reduce the out-of-pocket costs for beneficiaries during the Medicare prescription drug coverage gap.

The closure is being phased in over several years, with incremental improvements each year. In the coming years, it is expected that it will be completely closed. This means that beneficiaries will no longer have to pay the higher percentage of their covered prescription drug costs out-of-pocket while in the gap. Instead, they will pay a lower percentage, making their medications more affordable and accessible.

Will the Prescription Drug Part D Coverage Gap Go Away?

The future of the Part D prescription drug plan gap is a popular topic. Originally, the gap was implemented as a cost-saving measure and was intended to encourage individuals to use generic drugs, thus reducing overall healthcare expenditures. However, over the years, this has proven to be a burden for many Medicare beneficiaries, who face significant out-of-pocket costs when they fall into this gap. As a result, there have been ongoing discussions about the need to eliminate or modify this coverage gap stage.

The good news for 2023 is that the coverage gap phase is set to be fully eliminated in 2025. This means that Part D enrollees will no longer face heightened costs during this phase. Instead, they will continue to pay their regular cost-sharing amounts for prescription drugs throughout the year.

The elimination of the Medicare coverage gap phase is a significant improvement for beneficiaries. It removes a financial burden that many have faced in the past and aligns with the goal of providing more affordable access to necessary medications. Click here to learn more about Medicare Part D plans.

How does donut hole work with Medicare Advantage & Medicare Part D costs?

The donut-hole is also connected to Medicare Advantage plans that have a Part drug plan. These plans are also known as MAPD plans or Part-C.

MAPD plans, which are private insurance plans that provide Medicare benefits, often include Part DD plan drug coverage as part of their offerings. Therefore, it can also apply to those enrolled in MAPD plans. Since these plans often include drug coverage as part of their offerings, the coverage gap commonly can also apply to those enrolled in these plans. Click here to learn more about the Medicare Part-C program.


Out-of-pocket drug costs can take a toll on your wallet. Whether you have a Medicare Supplement insurance plan or an MAPD plan, your annual drug costs can be significant. Even if you don’t take any medications today, you should still get a Part-D plan to avoid a penalty. However, if you take medications and fill a prescription, your Part-DD plan should keep your overall costs lower compared to not having one.

It’s understandable if all of this is overwhelming. That’s why we created an easy to learn course to get you familiar with the Medicare system. People with Medicare rave about our free course.  The free course provides additional information about the different parts of Medicare, enrollment, costs, what Medicare pays and what it won’t and more.


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Judge dismisses Republican lawsuit against Google over Gmail’s spam filtering




The suit complained Google intentionally sent RNC political emails to Gmail users’ spam folders, and the RNC sought restitution for “donations it allegedly lost as a result” of those lost emails. The RNC cited a North Carolina State University study that found Gmail was more likely to mark emails from Republican campaigns as spam. One of the study’s authors spoke to the Post in May last year, saying its findings had been misrepresented. Muhammad Shahzad noted that it only tested default email settings — in tests on accounts where users indicated their preferences by marking some messages as spam, “the biases in Gmail almost disappeared.”

While US District Court Judge Daniel Calabretta described the RNC’s suit as a “close case,” he dismissed the Committee’s claims, writing that it had “failed to plausibly allege its claims” that Google’s filtering was done in bad faith. Google claimed that many of the filtered emails were likely picked up by its spam algorithms because of user complaints and pointed to problems with the RNC’s domain authentication and frequent emails as other culprits.

The judge also said Republican emails could be considered “objectionable” content based on the definition in the CAN-SPAM Act and said that Google designating them spam is protected by section 230 of the Communications Decency Act. The decision left Republicans with partial “leave to amend to establish a lack of good faith” on Google’s part.

#Judge #dismisses #Republican #lawsuit #Google #Gmails #spam #filtering

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Transparency in Coverage – price information accessible to the public




Are you ready to take charge of your healthcare like never before? In 2023 insurance carriers are rolling out an online price transparency tool available for 500 shoppable items and services. In compliance with Transparency in Coverage, subsequently implemented under the Affordable Care Act (ACA) of 2020.

Say goodbye to the days of uncertainty and hidden fees! With this tool, you’ll clearly understand what to expect, allowing you to plan and budget for your healthcare like a pro.

It’s a game-changer! You are finally able to inform yourself about the cost of that medical procedure you’ve been considering. Curious about the price of a specific service? An internet-based price comparison tool that allows an individual to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider. You can even request the same information over the phone by calling your insurance membership line.

We can’t stress enough how important it is for you to sign up with your provider’s member portal. It will help you to maximize your coverage and will provide you the power to manage your account seamlessly. In addition to accessing your explanation of the benefits of your past procedures, you will see how much you have paid towards the deductible and out-of-pocket maximum, you will be able to locate providers and hospitals in your network, be able to see your policy payment status, pay your premium online and also now be able to find the treatment cost estimator.

Blue Shield of California

Treatment Cost Estimator is a new tool already available for Blue Shield members. This calculates the overall cost and out-of-pocket expenses for frequent in-network medical procedures. Moreover, projections offer the members of transparency and clarity they need to budget and make future healthcare plans. Click 👇 here to view Blue Shield treatment cost estimator brochure.


Here’s for Kaiser members. Log in to your member portal, then click on the “benefits” tab. Scroll down, and subsequently, you will find the “Find cost estimates” section. The list of procedures is clickable therefore you can click on each to see their estimates.

kaiser member page


Anthem members should go and log on to Once the member logs on, they will click on “Care” at the top of the site; lastly, they will need to “Shop for Procedure”. You should be able to find the information you need.

LA Care

With LA Care’s utmost security over the phone, each member is welcome to call member services at 855-270-2327 to walk you through navigating the portal.


To make the most of your membership benefits, don’t forget to log in to your personalized Member Portal at It’s your gateway to a world of convenience and control over your insurance needs.

In addition, you have access to a dedicated Concierge team ready to assist you with any insurance-related inquiries. Simply give them a call at 855-672-2755 (opt#2), and they’ll be more than happy to walk you through this feature.

You can also contact your Care Team through direct messaging at [email protected]. Remember to include your OSC# and provide all the details to ensure a swift and accurate response.

Utilizing these cost estimation tools can save time and effort in understanding your health coverage costs. You will no longer have to spend hours poring over complicated insurance documents or making numerous phone calls to your insurance provider. Instead, you can access all the information you need at your fingertips and make informed decisions about your healthcare.

If you would like to discuss your health insurance options with a personal touch, feel free to reach out to us at 310-909-6135 or send us an email at [email protected]. We are here to provide dedicated assistance in safeguarding your future and protecting your loved ones today.

#Transparency #Coverage #price #information #accessible #public

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