Harver Health Insurance Group Tokyo News: Tax returns this year require health insurance information, government offers tips

Because 2015 is the first year Californians will have to provide information about their health insurance on their tax returns, the U.S. Department of Health and Human Services released a fact sheet detailing what they'll need to know, officials announced.

In the coming weeks, the administration will continue to provide added resources to help consumers prepare for tax filing season, including online tools to help individuals connect with local tax preparation services and determine if they are eligible for an exemption, officials said.

More than three quarters of tax filers will just need to check a box on their tax return indicating they had health coverage for all of 2014, but there will be added steps for those who bought coverage through the Health Insurance Marketplaces, or decided not to enroll in coverage. Those who had basic health insurance in 2014 meeting the Minimum Essential Coverage requirement for the Affordable Care Act won't receive any new forms in the mail and won't have to fill out new forms when they file their 2014 income tax returns.

What consumers need to know:

When you file your tax return, you'll need to check a box indicating you and your family had health insurance for all of 2014. Types of coverage that meets the Affordable Care Act's standards include: Most job-based plans, including retiree plans and COBRA coverage; Medicare Part A or Part C; Medicaid; the Children's Health Insurance Program (CHIP); most individual health plans you bought outside the Marketplace, including "grandfathered" plans.; If you're under 26, coverage under a parent's plan.

Filing electronically is the easiest way to file a complete and accurate tax return. Last year, some 85 percent of taxpayers e-filed. Electronic Filing options include free Volunteer Assistance, IRS Free File and professional assistance. Helpful resources available include the IRS Resource Guide: Health Care Law: What's New for Individuals & Families.

Last year millions of people purchased coverage through the Health Insurance Marketplace, and most benefited from a tax credit to lower their monthly premium. Those enrolled in such a plan must provide some basic information about their health insurance when they file their taxes. All Marketplace consumers will receive a new statement called a Form 1095-A  that includes all the information they need about their coverage to file their return. Form 1095-A will come by mail by early February. In most states, you can also download a copy of your statement through your Marketplace account starting in late January or early February. You must wait for your Form 1095-A to arrive before filing your taxes. If it hasn't come by early February, you should contact the Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325.

When you get your Form 1095-A, check the information on it like the number of people in your household for accuracy. If you find an error, call the Marketplace Call Center at 1-800-318-2596 to find out how to get a corrected form.

Keep your Form 1095-A with your other important tax information, like your W-2.

If a tax credit lowered your monthly health insurance premiums for 2014, you will use your Form 1095-A to input some basic information when you file your taxes. When you signed up for health insurance, you had to estimate your 2014 income, which determined the size of your tax credit. Now, you must compare your estimated income with your actual income which could impact the final amount of your tax credit, as can a change in your income or household size during the year. You may see a smaller refund or owe money back if you underestimated your income. You may also get a bigger refund if you overestimated you income.

If you owe money back, there are several repayment options available.

If you did not receive a tax credit to lower your monthly premiums in the Marketplace, you can visit HealthCare.gov/taxes/tools/ to get information you'll need to enter into your tax forms to see if you might qualify.

If your Marketplace coverage started partway through 2014 and you were uninsured earlier in the year, or if you were uninsured for only a short period of time during the year, you may be eligible for an exemption from the requirement to have health coverage. You can claim the exemption on your tax return when you file. The process is fast and easy, requiring only that you select the exemption that applies to you and enter the corresponding code.

Available helpful resources:

HHS Fact Sheet: 3 Tips About Marketplace Coverage & Your Taxes.

Use a tool to get information you may need to determine your 2014 premium tax credit.

Learn more about your taxes if you had a 2014 plan through the Health Insurance Marketplace.

IRS Resource Guide: Health Care Law: What's New for Individuals & Families.

Learn more about Payment Plans, Installment Agreements and Offers in Compromise.

While those who can afford health coverage but chose not to buy it may have to pay a fee, individuals who could not afford coverage or met other conditions can receive an exemption. If you qualify, receiving an exemption is simple and easy, and means you won't have to pay a fee. You can claim most exemptions on your tax return, but some exemptions are only available through the Marketplace.

There are a variety of exemptions available, including if:

The cost of coverage was too high. This applies to you if the lowest priced plan available to you would have cost more than 8 percent of your income. Visit HealthCare.gov/taxes/tools for information you may need to claim the 2014 unaffordable coverage exemption.

You were uninsured for only a short period of time.

You experienced a hardship, such as if you had medical expenses that resulted in substantial debt, if a close family member passed away, or if you experienced domestic violence, among other hardships. You will need to apply to the Health Insurance Marketplace to qualify for this exemption.

When you file your taxes, you will enter information about the months you had coverage and any exemptions you qualify for on your tax forms. If you could have afforded coverage in 2014 but chose not to buy it and you don't qualify for an exemption you will have to pay a fee with your federal tax return. The fee is based on your income and on how many months you didn't have coverage.

If you didn't have health coverage for all of 2014, you'll pay the higher of $95 per adult and $47.50 per child, without coverage, limited to a family maximum of $285, or 1 percent of your income, subject to certain caps.

Harver Health Insurance Counter Fraud Group: Health insurance options for ACA shoppers

Maine citizens looking to purchase health insurance on healthcare.gov now have more choices for their 2015 plans. We did a quick roundup of the 3 main players in the local health insurance field in Maine.

Anthem Blue Cross and Blue Shield. A veteran in the health insurance industry, Anthem has been around even before the launch of the Affordable Care Act website 3 years ago. In fact, it has registered over 18,000 Maine citizens as individual clients (i.e. customers who bought their own coverage instead of getting it through work benefits). Their enrolment rates is almost twice as high as their closest rival which is not surprising since they are getting corporate backing from WellPoint, one of the national health insurers with a big market share.

Almost 20% of the enrollees on the ACA site for 2014 plans  were through Anthem. So this year, they seem to be prepared for a big comeback with their premium rates reduced by 1%.

Harvard Pilgrim Health Care. A newcomer in the industry, the non-profit Harvard Pilgrim came to the market with 4 plans for 2015. Though relatively new, it's already familiar with health reforms from its partnership with the now-defunct Dirigo Health (Maine's effort to increase the number of citizens with health insurance).

Harver Health Insurance Counter Fraud Group noted that with 3 health insurers from which to choose from, Maine citizens are benefiting greatly in a growing competitive market, which is incidentally also a goal of the Obamacare.

Maine Community Health Options. This health insurer from Lewiston has around 80% share of Maine buyers in healthcare.gov's website in the primary enrolment period. This startup was created after the ACA (Obamacare) which provides loans for those who want to create health insurance cooperatives. A number of "co-ops" have already registered enrolment rates that are below their targets but Maine Community Health Options seems to be operating as a great example especially in providing reasonable prices.

This year, the premium rate for their most-availed plan decreased by around 0.5%. Their other premium rates were increased albeit on the less popular plans.

Harver Health Insurance Group Tokyo News: A Chief of Surgery Offers Insider Tips to Finding the Right Surgeon


On Sunday morning, my neighbor Carolyn knocked on my front door holding a basket of carbs and said, "I need to have my gallbladder out. I've never had an operation and have no idea how to find a surgeon to do my surgery. I don't want to die. I brought you some scones."

Carolyn brings up a valid point -- if you've been blessed with reasonably good health, you probably don't have a surgeon's number on speed dial. Therefore, the bigger question is, in the unfortunate event that you need one, how do you find the best surgeon for your medical condition?

Even routine operations have risks

Straightforward surgeries like gallbladder removal or hernia repair can result in occasional complications so it pays to choose your surgeon with care. But other than asking the doctor who recommended the surgery and running down the list of surgeons on your insurance plan, how do you narrow down the list?

I decided to go directly to the source and consulted with board-certified general surgeon Dr. Amit Kharod, chief of the Department of Surgery at CentraState Medical Center in Freehold, New Jersey for his recommendations.

"You are looking for a highly-skilled service provider with whom you are entrusting your life," Dr. Kharod says. "Take the time to perform proper due diligence so you will be comfortable with the caliber and quality of the surgeon you choose."

The doctor went on to outline tips for finding the right surgeon to meet your specific needs:

• Ask hundreds of people in five seconds

With a click of the "send" key, you can electronically reach out to friends, colleagues, neighbors and their friends for feedback and recommendations. The message you send can be as personal or indirect as you wish -- but social networking should uncover some solid leads.

• Nurses are in the know

Medical office and hospital-based nurses get feedback from patients and colleagues about different surgeons day in and day out. If there aren't any nurses in your social network, call your hospital of choice and ask the nursing director who she would chose if a loved one needed your type of operation.

• Confirm these key credentials

Ascertain that the surgeon is board-certified or board-eligible in his or her specialty by visiting the American Board of Medical Specialties and the Federation of State Medical Boards to make sure he or she is licensed in your state.

• Can the surgeon perform your operation laparoscopically?

Some, but not all, surgeons have undergone advanced training to perform many different procedures laparoscopically using state-of-the-art tools and technology, such as robotics. This can mean significantly less pain and faster recovery for you.

• How often and how many times has the doctor performed your surgery?

You want to see that the surgeon is actively performing this operation with consistently successful outcomes. This can be especially important for procedures which are new or uncommon. Over time, many surgeons tend to perform the certain surgeries with regularity and have dealt with complications before.

• Interview your top candidates

Ideally, meet with your potential surgeon/s in person or at least have a phone conversation. See how quickly you can get on his surgical calendar, also. Use this time to pose your key questions and concerns. Remember, you are purchasing an expensive service from the surgeon, not making a new friend.

After you've chosen a surgeon

Carolyn took Dr. Kharod's advice and discovered a great surgeon who had operated on her husband's colleague and was on staff at her preferred hospital. I reminded her to call the doctor's medical insurance administrator and re-confirm that the doctor, the anesthesiologist and the hospital accepts Carolyn's insurance.

Patients who feel confident in their choice of surgeon should feel more at ease before the operation, which is important. Studies conducted on pre-operative patients show that those with higher stress levels at the time of surgery can take as much as 25 percent longer to recover.

Dr. Kharod also advises people not to hesitate to ask doctors for references. "A good surgeon maintains a roster of satisfied patients who are willing to speak about their experiences under his care. Believe me, if I needed surgery, I would be doing the same thing."

To prevent and detect fraud within the health care and the insurance industry, Harver Health Insurance Counter Fraud Group will help you. The Harver Health Insurance Counter Fraud Group has official connections with health fraud investigation agencies.