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Do you really need an annual well visit and why is it so important?

What is the purpose of an annual well visit?

Your annual well visit or check up is something you should have each and every year.  Why?  Because it gives both you and your physician a baseline reading of your overall health while you are symptom free.  Having this baseline measurement can help your doctor detect potential health concerns before they progress – think of it as a warning system for your overall health. 

“An ounce of prevention is worth a pound of cure”

What can you expect during your annual well visit?

You can expect your physician to check the following during your next well visit

  • Health history
  • Height measurement
  • Weight measurement
  • Blood pressure reading
  • Body mass index assessment (BMI)
  • Counseling for obesity
  • Skin cancer and safety
  • Depression screening

During the overall visit with your doctor, he or she will determine if there is a need for additional tests, lab work, x-rays and other medially appropriate health screenings based on what the baseline measures report.

Embrace the opportunity you have to go for an annual well visit every year.  These visits can help you avoid potentially serious health conditions.  They can also provide early diagnosis for diseases that can be easily treatable if caught early enough – things like diabetes.  Allowing health concerns like diabetes to go unchecked for a prolonged amount of time can do serious, irreversible damage.

Curious to know how the Affordable Care Act’s annual check up has helped real people?  Check out the stories below!

All names have been changed.

Rich had not had a checkup in many years and after getting insurance for the first time in as many years he went for a checkup.  The doctor saw something irregular on his EKG and sent Rich for further testing. Turns out Rich had a blockage in a small artery and needed a procedure to open it up.  What was an outpatient procedure could have been life threatening if it went on undiscovered.

Samantha has had insurance for many years but had not had a checkup in about 4 years.  When she went this past February a small nodule was found in her breast that needed further study.  The nodule turned out to be nothing to worry about but its very important to have these things checked.

Don also had insurance for many years and had not been to a doctor in about 5 years.  After showing the doctor a mark on his leg, the doctor sent him for additional tests.  The spot turned out to be skin cancer that was easily removed at the stage that it was in.  Had it gone on longer, it could have been an issue.

Tips to make your upcoming well visit productive:

  • Be very specific when you call to schedule your appointment – indicate that you need an appointment for your annual well visit
  • Make sure the doctor’s office codes your visit properly so you do not get charged erroneously
  • If you think you have been charged incorrectly, ask to see the codes your doctor’s office uses for well visits
  • Make a list of questions and concerns you would like addressed during your visit
  • Know what is included in your annual well visit – visit a blog post I wrote earlier this year that outlines what is included HERE

Here’s to continued health!


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Are You Taking Advantage of Your 2017 Health Plan?

If not, you should be!  The Affordable Care Act is in place to help you be healthy and remain healthy throughout your life!  A BIG part of helping you stay healthy is through preventative health care practices.  The Affordable Care Act provides several preventative services as well as 1 wellness visit each and every year.

In this blog post, we are going to explore what is included in your well visit and showcase why it is important to take advantage of your it through real life stories.  The stories we share with you will illustrate how preventative care and well visits stopped devastating illness in its tracks.  The key to preventative health care is catching illness and disease before they manifest and fester into a larger more chronic or fatal outcomes.

So what exactly is “Preventative Care”?  It is the practice of evaluating your health when you are not sick or experiencing any sort of symptoms, providing a baseline or what is normal for you.  Once you have a baseline established for yourself, it makes it easier for healthcare professionals to identify illness and disease earlier.  This makes it easier to establish when something serious is brewing within your body.

Did you know there are at least 10 preventative services and 1 well care visit available to you during the calendar year under The Affordable Care Act?  Many people don’t!  These preventative services are made up of one well care visit as well as things like immunizations, tests, physical exams and lab work.

Captain Health USA Stat: The Affordable Care Act allows for 47 million women with private insurance to schedule mammograms without being charged a co-pay

Curious what you could expect during your annual well care visit?

Under The Affordable Care Act it is required by law that you have access to 10 main preventative care services.  Below is what is included in the “Adult” list.  Keep in mind, there are even more listed for women, children and seniors!

  1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  2. Blood Pressure screening for all adults
  3. Lab Tests such as Cholesterol screening and others
  4. Colo-rectal Cancer screening for adults over 50
  5. Depression screening for adults
  6. Diabetes (Type 2) screening for adults with high blood pressure
  7. HIV screening for everyone ages 15 to 65, and other ages at increased risk
  8. Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster
    • Human Papillomavirus
    • Influenza (Flu Shot)
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Tetanus, Diphtheria, Pertussis
    • Varicella
  9. Obesity screening and counseling for all adults
  10. Tobacco Use screening for all adults and cessation interventions for tobacco users

Real Life Stories… (all Names Changed)

John……    Didn’t have insurance for many years due to the cost.  About 2 years ago he got coverage and decided to go for his physical.  The first physical in about 10 years.  At first all seamed well.  Then the lab work came back.  The labs showed that his blood sugar was way off from what it should be.  Turns out John was a diabetic and didn’t know it.  He simply ignored the symptoms.  Over time it could have been a huge medical issue however, since it was caught fairly soon, John got on medicine and should live a normal life.

Rick……  Rick had not had insurance for about 5 years.  Rick got a physical at the first chance he could and it was a good thing he did.  An issue with his prostate was caught in the early stages and was able to be treated with out major surgery.  Had it not been caught it could have cost him his life.

Joan…… To make a long story short, the non-compliant health plan Joan was on did not cover the cost of a mammogram .  Once she got good coverage, Joan had a mammogram (that cost nothing)  for this first time in 4 years.  A very small abnormality was found and removed.  Had it not been found early on, the treatment and results could have been much worse.

Health insurance is not just for when your sick, its also there to keep you well.


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What’s In Store For Obamacare?

As we quickly approach the end to Trump’s 100 days in office (April 29, 2017), many are curious as to where we stand when it comes to Obamacare AKA The Affordable Care Act.  At the beginning of his campaign, Trump made a lot of promises and proclamations about repealing Obamacare.  Since the election, the republicans has toned down their stance.

What Plans Does the New Administration Have for Obamacare?

The Republicans recently revealed what their big plan is when it comes to The Affordable Care Act.  One of the most glaring changes in their proposal is the name given to Obamacare.  Their proposal changes the name from The Affordable Care Act to The American Care Act.  Some of the other changes we may see under the new Administration include:

  • Removing the requirement of having insurance or risk the consequence of suffering a fine
  • Ending Obamacare taxes on the wealthy
  • Changing how people get financial aide needed in order to purchase health insurance coverage on an individual level

Keeping in mind that this is still in the proposal stages, other items on the table for approval are:

  • Changing the way the Medicaid system is funded
  • Eliminate the rule that requires companies with 50 or more full time employees provide health coverage or pay a fine
  • Ending subsidies for out of pocket costs for low income Americans
  • Creating a new system of financial aid and penalties for those who allow coverage to lapse
  • Tax credits based on age – starting at $2,000 for those in their 20’s with a gradual increase to $4,000 for those aged 60 and over available to individuals who earn up to $75,000 and households up to $150,000
  • Insurers allowed to charger older citizens premiums up to 5 times the rate of younger people which is different from Obamacare’s 3 to 1 rate
  • Not giving states the authority to expand their Medicaid programs to all adults by 2020 after which date no newly eligible adults could sign up

The bill will still include:

  • Pre-existing conditions where insurers cannot deny coverage or charge higher rates to people with pre-existing conditions
  • The ability for adults under the age of 26 to get coverage from their parents plan
  • The 10 essential health benefits set up by The Affordable Care Act
  • The fact that insurers will be barred from setting maximum limits on benefits paid out

While there are many changes on the table, there are many items that will not change.  The republicans look to make changes to drive down costs while providing quality health insurance at more affordable prices. Some may challenge this by saying the plan will remove coverage from many Americans who couldn’t afford it previously.

Stay tuned as we continue to learn more about what actually ends up being approved.

If you have questions about your coverage or getting covered, contact me today!

I can be reached at: (813) 391-3448 or email me at Dave@YourObamacareGuy.com


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Understanding the Different Health Insurance Options Available To You

When it comes time to select an insurance plan, which will you choose?  An HMO? PPO? EPO?  What do the acronyms mean and what are the differences?  This blog article will give you clear, concise understanding so you can make an informed decision when it comes time to choose or change your healthcare plan.

HMOs:  Health Maintenance Organization Plans

yocg-wednesday-10-26-16-canvaThis plan centers around a Primary Care Physician or a PCP.  Essentially, your PCP manages and coordinates your healthcare, referring you to specialists and hospitals within a designated network.  It is important to note that only those in-network services referred by your PCP will be covered by the plan.

PPOs:  Preferred Provider Organization Plans

PPO plans allow you and your family to receive care from any health care provider they choose within the insurance company’s network.  This list of providers can include specialists.  The major difference with a PPO is that a referral from your primary care physician or PCP is not required.  This type of plan is generally preferred by those individuals who tend to se a specialist on a regular basis.

EPOs:  Exclusive Provider Organization

This type of plan gives you access to all the providers and specialists within the EPO network.  EPO plans usually do not offer coverage outside of the network unless it is an emergency.  

POS:  Point of Service Plans:

This plan acts as a hybrid between the HMO and PPO.  In this type of plan, you usually select a primary care doctor for routine visits such as check ups as well as for specialist referrals.  The difference is, you are permitted to utilize providers outside of the network, but, you can expect your out-of-pocket expenses to be hight.  Additionally, you will be subject to copays and deductibles.  This type of plan works well for those who like the extra flexibility and who are willing to pay a little be more.

HDHP:  High Deductible Health Plan

yocg-thursday-10-20-16-canvaThis type of insurance plan has high deductibles which you must meet before the health insurance coverage actually goes into effect.  People attracted to this type of plan are those who want to save money on the monthly premiums.  These are also people who don’t intend on using their medical coverage as often as others.

This type of plan may also be used with a Health Savings Account or an HSA where the individual contributes to the account on a pre-tax basis allowing them to pay for healthcare expenses and deductibles.

Now that you are aware of the various plans available to you during open enrollment, you can make an informed decision.

Still have questions or concerns?  Contact me today!  I can be reached at (813) 391-3448 or Email me at Dave@YourObamacareGuy.com


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2017 Open Enrollment…Are you READY?

It’s that time of year again!  Get ready to start thinking about open enrollment and what you need to do to make sure you and your family have health insurance coverage.

Here is what you need to know!

2016:

Open enrollment for 2016 is CLOSED.  BUT, If you still need coverage for the rest of 2016, you can get it but, only if you qualify. 

To qualify you need to meet one of these two criteria:

  • Special Enrollment Period due to a life event — like losing health coverage, getting married, or having a baby.
  • You qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

You can apply for these programs any time throughout the year.

Let’s Brush Up On The Marketplace

About The Marketplace:

Who is it for?  The Marketplace is for individuals who do not have health coverage for the coming year.  That means, you do not have coverage through:

  • Your employment
  • Medicare
  • Medicaid
  • The Children’s Insurance Program (CHIP)
  • Another source providing qualifying coverage

How Much It Costs:

Health insurance through the Marketplace depends on your estimated income for the coverage year.  Did you know?  In 2017, roughly 8 out of 10 of uninsured people who are eligible for Marketplace coverage will qualify for financial assistance.*  The financial assistance  provided goes towards lowering the cost of the monthly premiums and in some cases is can also help with things like deductibles and copays.  Get an idea of what that could mean for you HERE.

Discover What The Marketplace Insurance Covers:

Essential health benefits – Every plan must include the following:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
  • Pre-existing conditions, including pregnancy
  • Preventive care
  • Birth control coverage
  • Breastfeeding coverage

Pre-existing conditions, including pregnancy

Preventive care

Get a list of what that includes for:

What If You Do Not Get Health Insurance?

If you can afford health insurance and fail to obtain qualifying health coverage for the 2017 year, you may be fined.  This fine is referred to the “individual shared responsibility payment”. 

Fees are calculated in two different ways.  They are:

  • A percentage of your house hold income
  • Per person

You will be required to the highest rate calculated.

Fines for 2017 have not been released as of yet.

Do you have questions about your health insurance coverage for 2017?  I can help!  Contact me, Your Obamacare Guy!  I can be reached at:  (813) 391-3448 or email address:  dave@YourObamacareGuy.com

* source:  http://www.HealthCare.gove/quickguide


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Subsidies, Deductibles & Premiums…OH MY!

Obamacare Guy Thursday 10 15 15Open Enrollment has OFFICIALLY begun!  As of November 1, 2015, you can get covered, change health plans or upgrade your current health plan without needing a change in life status.  AND…Right about now you may be in the midst of learning more than you ever needed to know about your income and how it relates to the Affordable Care Act’s (a.k.a. Obamacare) subsidies and deductibles.

This blog post is going to help you tremendously as we explore what a subsidies are, how you get them and how you can qualify for lower deductibles.

What Are Subsidies?

A subsidy is financial assistance you receive to help pay for health insurance coverage. A subsidy reduces your cost for insurance.

You may also qualify for reduced deductibles, and reduced co-pays.

Who Benefits From Subsidies?

Subsidies were designed to help low to moderate income Americans afford health insurance coverage.

To receive subsidies, you must have coverage on a plan in the Marketplace.

There are 3 types of subsides or cost assistance a person can receive.  They are;

  • Advance Premium Tax Credits which are used to lower premiums
  • Cost Sharing Reduction to help lower out-of-pocket costs
  • Medicaid and CHIP

How are Subsidies Calculated?

Your Obamacare Guy Tuesday 10 13 15 CANVASubsidies are calculated based on income and are available to people and their families who have an income level between 100-400% of the Federal Poverty Level.  Many people refer to this as the “FPL”.

NOTE:  The FPL or Federal Poverty Level adjusts every year to account for inflation.  This adjustment allows more citizens to quality for subsidies.

Specifically, the calculation used is something called MAGI or Modified Adjusted Gross Income.

MAGI is sum of the following:

Adjusted Gross Income +
Non-Taxable Social Security Benefits +
Tax-Exempt Interest +
Excluded Foreign Income
_________________________________
= MAGI (Modified Adjusted Gross Income)

Once you qualify for subsidies there are some points you should be aware of:

  • Subsidies are only valid on Plans purchased in the marketplace
  • Your marketplace health insurance plan cannot cost you more than 9.5% of your income AFTER tax credits are applied
  • The amount of cost assistance you can gain is based on the second lowest cost of the Silver Plan in your state’s marketplace

Who is NOT Eligible for Subsidies?

  • People reporting over 400% of the FPL will not be eligible for cost assistance
  • Those who have access to affordable, employer-based health insurance
  • People eligible for Medicare
  • Those who fall into the Medicaid gap

NOTE:  People who are making under 138% of the FPL are eligible for Medicaid.

When can I Apply for Subsidies?

Open enrollment is the PERFECT time to apply for subsidies and cost assistance.  If you don’t apply during open enrollment, you will need to wait until the following year’s open enrollment period or if you experience a life qualifying event.

Exploring Deductibles…

Obamacare Guy Tuesday 10 6 15 CANVAWhat is a deductible?

This is the amount of money you need to pay out-of-pocket for covered services before you insurance begins to pay.

This amount does NOT include:

  • Insurance Premiums
  • Costs that are NOT covered by your plan
  • Deductibles re-set every policy period

What happens after I meet my deductible?

Once you meet your deductible, your health insurance plan will pay it’s portion of your coinsurance.

Now that we know the basics of deductibles, discover how Obamacare has impacted them.

Here are some FAST FACTS pertaining to IN-NETWORK deductibles:

  • Obamacare mandates that major medical plans must meet specific cost sharing deductibles
  • Deductibles cannot be hight than out-of-pocket limits
  • Individual out-of-pocket limits are $6,600 (2015 figure)
  • Family out-of-pocket limits are $13,200 (2015 figure)

Deductibles – The More You Know…

Here are some quick tips you should be aware of when thinking about deductibles.

  • Deductibles start when your policy begins
  • Policy periods usually run from January 1st and ends December 31.  To ensure that you are taking full advantage of your policy period, make sure you are enrolled in a plan by December 15.
  • If you switch your plan mid-year, you may lose any deductibles already utilized
  • If switching plans during the year, try to use the same carrier to see if deductibles can be rolled over
  • Low deductible plans usually have higher premiums
  • High deductible plans tend to have lower premiums
  • Premiums do not count towards your deductible
  • Co-insurance usually does not start until deductibles are met
  • Co-pays usually go toward deductibles and out-of-pocket maximums

Obamacare Guy 9 30 15 CanvaThere is A LOT to consider during open enrollment and it can be confusing.  The best thing you can do for you and your family is to get sound advice from a professional.  As Your Obamacare Guy, it is my mission to help you get covered with the best plan and help you get the subsidies you need.

Call me today for help navigating your options when it comes to health insurance:  (813) 391-3448 or email me:  Dave@YourObamacareguy.com

Glossary of Terms:

Co-Pay/Co-payment:
A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.

Coinsurance:
Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You pay coinsurance after you’ve met your deductible. For example, if the health insurance plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your 20% coinsurance payment would be $20. The health insurance plan pays the rest.

Cost Sharing:
The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums.

Deductible:
The amount you owe for covered health care services before your health insurance plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve paid $1,000 for covered services. Some plans pay for certain health care services before you’ve met your deductible.

FPL:
A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits.

(The amounts below are 2015 numbers and used for calculating eligibility for Medicaid and the Children’s Health Insurance Program (CHIP). 2014 numbers are used to calculate eligibility for savings on private insurance plans for 2015.

•$11,770 for individuals
•$15,930 for a family of 2
•$20,090 for a family of 3
•$24,250 for a family of 4
•$28,410 for a family of 5
•$32,570 for a family of 6
•$36,730 for a family of 7
•$40,890 for a family of 8

MAGI:
The figure used to determine eligibility for lower costs in the Marketplace and for Medicaid and CHIP. Generally, modified adjusted gross income is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have.

Premium:
The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

Subsidy:
Health coverage that’s obtained through financial assistance from programs to help people with low and middle incomes.

Glossary of terms were provided by:  HealthCare.gov


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2016 Healthcare Open Enrollment FACTS & FIGURES!

2016 Healthcare Open Enrollment FACTS & FIGURES!

Obamacare Guy 9 29 15 Canva2016 Open Enrollment is fast approaching.  Hurry!  Grab your calendar!  It is time for you to mark some VERY important dates on your calendars.  If you miss these dates, it could mean the difference between paying healthcare penalty fees or not.

The following dates relating to obtaining health insurance coverage have been posted by healthcare.gov:

Late October:

Prices for health insurance plan rates purchased in the Health Insurance Marketplace will be published late October.

November 1, 2015:

This day marks the FIRST day of Open Enrollment.  Starting on November first you can obtain healthcare coverage through the Health Insurance Marketplace.  Coverage can start as early as January 1, 2016.

December 15, 2015:

This is the very last day to enroll or change plans and still have them be in effect for January 1, 2016.

January 1, 2016:

This is the first day of coverage for those who purchased plans and enrolled by December 15, 2015.

January 15, 2016:

There is still time to get covered!  This is the last day for you to obtain coverage or make changes to coverage and have them be in effect for February 2, 2016.

January 31, 2016:

This is the LAST day of open enrollment.  All enrollments and changes administered between January 16 and January 31, 2016 will be in effect on March 1, 2016.

I Recorded the Dates and Deadlines, Now What?

Obamacare 9 1 15 CANVA-2Now that you know WHEN you need to get coverage by, it is important for you to know how much coverage you need in order to qualify.

There is a specific list of plans or policies that are NOT considered as “minimum essential coverage”.  Those plans or services include:

  • Vision Care
  • Dental Care
  • Workers’ Compensation
  • Disease specific coverage
  • Plans offering discounts on medical services

 

Below is a list of plans or options you can use and qualify as “covered” by health insurance:

  • Purchase of any Marketplace health insurance plan
  • Individual health insurance plans you may already have in place
  • Health insurance offered by an employer
  • Retirement plans
  • COBRA Coverage
  • Medicare Part A
  • Medicare Part C
  • Children’s Health Insurance Program (CHIP)
  • Coverage on a parental plan if you are a dependent aged 26 years or younger
  • Self-funded healthcare plans for students offered by universities*
  • Peace Corps volunteers health coverage
  • Certain veterans plans offered by the Department of Veterans Affairs
  • Most TRICARE plans
  • Department of Defense Non-appropriated Fund programs
  • Refugee Medical Assistance
  • State high risk pools**

For a more detailed list, visit:  http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Minimum-Essential-Coverage

*These plans are specific to policy years that began on or before December 31, 2014.  Please check with the university for clarification and more information as to whether or not the plan is in line with “Minimum Essential Coverage” policies.

**Plans eligible are those that commenced on or before December 31, 2014.

What if I Don’t Get Health Insurance

Failure to Get Health Insurance Could Cost YOU!
What happens if you don’t enroll in a health insurance plan by January 31, 2016?  You may have to pay a fee for failing to get health insurance coverage.  The fee for not having health insurance in 2016 has INCREASED since 2015.

Here are some facts and figures you must consider before Open Enrollment Ends on January 31, 2016:

If you fail to get coverage in 2016 you could end up paying the higher of the two amounts listed below:

Dollar Amount #1:  2.5% of your annual household income

Dollar Amount #2:  $695 per person (children under 18 are calculated at $347.50/child)

There are some other timing circumstances to take into consideration when talking about failure to have health insurance coverage.  See the Q & A segment below:

Q: What if I was uncovered for a portion of the year?

A: You would pay 1/12 of the annual penalty for each month you were not insured.

NOTE:  if you did not carry insurance for 2 months or less, you would not have to make a payment

Q: What if I was unemployed?

A: Penalty fees for not carrying insurance is based on your household income.  If it is determined that healthcare insurance was unaffordable based on your income, you could possibly qualify for an exemption.

Other Important Questions You May Have…

How will I pay?

This payment will take place when you file your taxes.  More specifically, it will be included on the tax return for the year you did not have health care insurance coverage.  For example, if you did not have health insurance during 2015, you would pay the penalty fee when you file your taxes on or before April 15, 2016.

What will happen if I fail to pay the penalty fee for not having healthcare insurance?

The Internal Revenue Service will withhold the amount you owe from any tax refunds you may get in the future.  You will NOT experience any:

  • Liens
  • Levies
  • Criminal penalties

Now that you know, what is considered as minimal essential healthcare coverage, who needs it and by when, it’s time to get you covered!  As “Your Obamacare Guy”, I am dedicated to help you get the best and most affordable health insurance plan for both you and your family.  If you are confused, have questions or need help navigating through the Marketplace, call me!  You can reach me at:  (813) 391-3448 or email me:  dave@YourObamacareGuy.com.

Sources:  healthcare.gov