Affordable Care Act, Year 2: Open enrollment now open

By Greg Grisolano, Land Line staff writer | Friday, November 14, 2014

With enrollment in the health insurance marketplace officially open, there are some important dates, deadlines and need-to-know information for truckers.

First off, if you are not already enrolled in a public or private health care plan or do not have health insurance through an employer-provided plan, the open enrollment period is the time to purchase coverage or risk paying a tax penalty.

Those who purchased plans through a public or private insurance marketplace will have the opportunity to renew the same plan or shop for different coverage during the open enrollment period. In most instances, you will be automatically re-enrolled in your same plan; however, if your insurance company withdraws from the particular state marketplace you are in altogether, your coverage will lapse and you will need to pick a new plan and provider.

The two most significant changes are the new dates for the open enrollment period, which will be from Nov. 15, 2014, to Feb. 15, 2015, and the tax penalty increase to 2 percent of your yearly household income for not enrolling in a qualified plan.

With the Feb. 15 cutoff, this year’s open enrollment period will end six weeks earlier than last year. It’s also crucial to remember that your enrollment date is not the same thing as your effective date. For example, if you enroll in coverage on the first day of the open enrollment (Nov. 15, 2014), your coverage won’t become effective until Jan. 1, 2015. If you enroll between Dec. 16 and Jan. 15, your coverage starts Feb. 1, 2015. If you enroll between Jan. 16 and Feb. 15, your effective date is March 1, 2015. 

While the start of last year’s open enrollment was marred by issues with the website HealthCare.gov, the extended enrollment period eventually allowed more than 8 million Americans to sign up for health insurance. As of October 2014, 7.1 million people were still enrolled and paying premiums.

According to a report from the Kaiser Family Foundation – a nonprofit, nonpartisan research group specializing in health care issues and policy – premium contributions, out-of-pocket spending limits, and tax penalties are all increasing in 2015. The Foundation also reports that on average, rates on the so-called “benchmark plans” declined roughly 0.2-percent nation-wide.

Both the Kaiser Family Foundation and other health insurance professionals say that it’s too soon to predict what, if any, changes or ramifications to the health insurance law may come about as a result of either the 2014 mid-term Congressional elections, or the U.S. Supreme Court’s decision to hear another case challenging an aspect of the landmark health care reform law.

Rick Welsh, president of Welsh and Associates, a Kansas City-based health care and insurance consulting business that works with OOIDA’s Medical Benefits Group, said consumers and health insurance providers “can only proceed forward with the law as it is today.”

“I think it is reasonable to anticipate further modifications to the law, especially given the most recent elections,” he said. “But I do not see a complete ‘repeal’ of the law, only further modifications.”

Critics and opponents of the law have touted a recent decision by the Supreme Court to hear arguments in King v. Burwell; a decision on that case will decide whether or not the language of the law allows for subsidies to be offered to people who buy their insurance through the HealthCare.gov marketplace.

“I think the important thing to remember, without speculating on the outcomes of the pending Supreme Court case, is that the Individual Mandate, which is the part of the law that requires people to purchase or be enrolled in a qualified health care plan, is not what’s at issue,” Welsh said.

“In fact, the Individual Mandate has already withstood one direct challenge by the Supreme Court in 2012, and it was affirmed. Therefore, regardless of what the Court may decide with regard to subsidies through the federal exchange, people are still going to be required to have insurance or risk being assessed the tax penalty, which is doubling this year,” he said.

Customers who purchase health insurance through a private exchange such as OOIDA’s are not eligible for federal tax subsidies. In order to qualify for the subsidies, insurance must be purchased through state or federal exchanges. Furthermore, those applying for subsidies must fall between 133 percent and 400 percent of the federal poverty level in order to qualify.

Qualifying events include marriage, divorce, and loss of insurance through job loss. Another qualifying event unique to the Affordable Care Act will be moving from one state to another.

“The one caveat that the ACA has added is if you do move, from one state to another geographically, because there’s certain areas of the country that have plans available and if you happen to move, that obviously changes. The plan you have may not be in place, or there may be more choices that you didn’t have before,” Welsh said.

Coverage terms for health insurance plans now ends on Dec. 31, rather than on the anniversary of the date of purchase, so even those who had a qualifying event and bought insurance mid-year must renew or purchase new coverage for 2015 during the open enrollment period.

Just like last year, OOIDA is offering a private insurance exchange for members to purchase ACA-compliant insurance plans, as well as supplemental coverage options for members and their families.

This year’s program has been expanded to 41 states. By law, private insurance exchanges like OOIDA’s are not authorized to sell insurance in New York and New Jersey.

OOIDA’s exchange is available with multiple carriers, including Assurant, Humana, and most of the Blue Cross and Blue Shield affiliates.
 
The Association will have links to an online enrollment portal on the OOIDA website. The portal is similar to federal and state exchanges, where members can enter their information and get quotes directly from OOIDA’s insurance partners.

Although the Individual Mandate requires most Americans to carry a minimum level of insurance coverage, there are some important exceptions and special qualifications. Those exemptions include certain religious groups and Native American tribes; undocumented immigrants (who are also not eligible for insurance subsidies); incarcerated individuals; people whose incomes are below the threshold for filing tax returns, and people for whom health insurance is considered unaffordable – where insurance premiums after employer contributions and federal subsidies exceed 8 percent of family income.

The Affordable Care Act also sets limits on the maximum amount of out-of-pocket medical expenses you can pay in a calendar year. For 2015, those amounts are $6,600 for an individual, and $13,200 per family.

For individuals and families who purchase insurance through a state or federally administered exchange, such as HealthCare.gov, advanced premium tax credit subsidies are available. Those credits must also be renewed during the open enrollment period. Those who received Advanced Premium Tax Credits paid monthly during 2014 will also receive a new tax form, 1095-A. Tax filers must use Form 8962 to reconcile credits with the amount paid in premiums. If you took less money than you needed in credits, you’ll get the difference back in your federal income tax refund. If you took too much, you’ll pay it back, although the amount to be paid back is capped based on income.

The new federal poverty level cutoff is $62,842, or 400 percent above the federal poverty level. Anyone who earns less than that amount in yearly household income, and who is not otherwise offered coverage from an employer or a spouse’s employer, may be eligible for subsidies on insurance plans purchased through the federal marketplace.

The Kaiser Family Foundation’s updated Health Insurance Marketplace Calculator can be found here.

Consumers with questions are encouraged to call the HHS call center at 800-318-2596 or visit HealthCare.gov where they can find local help. Agents in OOIDA’s Medical Benefits Group are also available from 7:30 a.m. to 5:30 p.m. CST, Monday through Friday at 800-715-9369 or via email at medben@ooida.com.

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