For Help Please Call JayMar Insurance Agency Today at 516-605-2757 or 631-875-2993

 

As an agency promoting a socially responsible New York, JayMar has made it our business to help as many individuals and their families in New York get quality, affordable health coverage as we can.  We specialize in the Affordable Health Care Act (aka Obamacare) and we are particularly savvy about navigating the NYSOH Exchange.  We feel that our knowledge of the law and how it applies to New Yorkers in particular is unmatched in the industry.  We want you to know that we are not just insurance agents; we are educators and advocates.  We clarify the ambiguities and debunk the myths.

For Help Please Call JayMar Insurance Agency Today at 516-605-2757 or 631-875-2993

 

Our process: Our intake sessions are thorough and take an average of one hour (with an additional 15 minutes for the enrollment portion of the process.)  During the session we will gather information about you and your family, including where you live, names and ages of each family member, occupation and income, current/prior insurance and basic health histories.

 

We determine the carrier primarily based on:

 

• Where you live
• Your preferred doctors and hospitals
• Your household income – to determine whether or not you qualify for an APTC (advance premium tax credit AKA subsidy)*

 

We determine your plan primarily based on:

 

• Medical conditions
• Prescription medications (generic, preferred brand, non-preferred brand, specialty)
• Anticipated inpatient/outpatient surgical procedures or hospitalizations

 

Once we have identified the right carrier and plan for you, we provide an in-depth explanation of the plan’s benefits as well as definitions of relevant health insurance terms you may or may not be familiar with. 

 

For Help Please Call JayMar Insurance Agency Today at 516-605-2757 or 631-875-2993

 

 

 

Carriers We Work With

(Plans are available both On and Off Exchange)

 

Health Republic of New York

Oscar Health Insurance

Empire Blue Cross/Blue Shield (Pathways Network)

NSLIJ CareConnect

Emblem Health

United Health Care (Compass Network)

Oxford (Liberty Network)

 

For Help Please Call JayMar Insurance Agency Today at 516-605-2757 or 631-875-2993

The carriers we work with have vast, high quality networks – up to 100,000 providers – which include HMO’s and EPO’s available to individuals and families.

 

• An HMO (Health Maintenance Organization) is a type of managed care in which you must choose a Primary Care Physician who is primarily responsible for your health care.  If you need to see a specialist, you must visit your PCP first in order to obtain a referral.  There are no out-of-network benefits on this type of plan.

 

• An EPO (Exclusive Provider Organization) is also a managed care plan and is similar to an HMO, you are not required to designate a PCP and you are NOT required to obtain a referral in order to see a specialist.  There are no out-of-network benefits for this type of plan.

 

• All carriers have “standard plans,” meaning that the benefits, deductibles, copays/coinsurance, and out of pocket maximums are identical across carriers within their metal tier: platinum, gold, silver, bronze.  If the plan you choose includes a deductible the deductible must be met before the insurance covers any of the costs for services, however ALL prescription drugs are exempt from the deductible.  There is NO CHARGE for preventive care.

 

• Some carriers also offer “non-standard plans” in order to provide more flexible options in terms of out of pocket costs and additional benefits.  Some plans include certain services not subject to the deductible such as primary care visits, specialist visits, diagnostic tests, imaging and lab work.  Some carriers even have plans in which generic drugs are FREE.  These are just some examples of the creative plan designs available.  (Keep in mind, these plans are not necessarily “better” than standard plans, as individuals’ needs vary). 

 

Additional potential benefits you could enjoy include a separate network of alternative healthcare practitioners providing discounted services on things like acupuncture, yoga, and massage – just to name a few; a nationwide network of urgent care facilities; and free, unlimited, nationwide Telemedicine!  

 

Individuals may only enroll in a plan during the Open Enrollment Period from November ^1st, ,2015 through January 31^st ,2016.

 

However…if you have a qualifying life event you may be eligible to enroll in a qualified health plan (QHP)** at anytime during the year, provided you have not gone without essential health coverage for more than 60 days.  Qualifying life events include the following:

 

 

• •Loss of minimum essential coverage
• •Marriage or domestic partnership, birth, adoption, or placement in foster care
• •Becoming a citizen, national, or lawfully present individual
• •For those already enrolled in a QHP, becoming newly eligible or ineligible for tax credits; or eligible for a different amount of cost sharing reductions
• •Permanent move to NY, or permanent move from one county to another within NY
• •Marketplace staff or contractor enrollment error
• •Assistor misconduct
• •Qualified Health Plan violated a provision of its contract
• •American Indians can enroll or change plans one time per month throughout the year

Other exceptional circumstances, as defined by HHS.

For Help Please Call JayMar Insurance Agency Today at 516-605-2757 or 631-875-2993

 

* A tax credit that can help you afford coverage bought through the Marketplace. Sometimes known as APTC, “advance payments of the premium tax credit,” or premium tax credit. Unlike tax credits you claim when you file your taxes, these tax credits can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you’re due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return. (www.healthcare.gov).

 

**Under the Affordable Care Act, starting in 2014, an insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements. A qualified health plan will have a certification by each Marketplace in which it is sold. (www.healthcare.gov). 

IF YOU ARE A FREELANCER AND NEED HELP UNDERSTANDING WHAT OPTIONS ARE AVAILABLE TO YOU PLEASE VISIT OUR SITE                                    www.FreelancersInsuranceHelp.com

 IF YOU NEED MORE HELP IN UNDERSTANDING HOW THE AFFORDABLE CARE ACT AKA OBAMACARE SPECIFICALLY EFFECTS LONG ISLANDERS PLEASE VISIT www.LongIslandObamacare.com

 

 IF YOU NEED MORE HELP IN UNDERSTANDING HOW THE AFFORDABLE CARE ACT AKA OBAMACARE SPECIFICALLY EFFECTS RESIDENTS OF NYC PLEASE VISIT OUR SITE www.newyorkcityobamacare.com