Affordable Care Act, Year 2: Deadline for Jan. 1 coverage is Dec. 15

By Greg Grisolano, Land Line staff writer | 12/12/2014

An important deadline is looming for those who don’t already have health insurance through an employer or who haven’t yet purchased a qualifying health care plan for 2015 through a public or private insurance exchange.

The deadline for enrolling in coverage that will take effect on Jan. 1, 2015, is this Monday, Dec. 15. 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.

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. The open enrollment period ends on Feb. 15, 2015.

Brenda Smith, OOIDA Medical Benefits Group manager, said Monday represents a key deadline for ensuring no interruptions in health care coverage to start the new year, and encouraged those in need of insurance to contact her department for assistance.

The Association’s insurance 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.

Members can work with an agent over the phone or also get quotes and even apply for a plan by visiting the OOIDA website and exploring the online enrollment portal here. The portal is similar to federal and state exchanges, where members can enter their information and get quotes directly from OOIDA’s insurance partners.

After Feb. 15, the only way to purchase a qualifying health insurance plan will be through a qualifying event. 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.

If you enroll in coverage after Dec. 15, your insurance won’t become effective until Feb. 1, 2015. If you enroll between Jan. 16 and Feb. 15, your effective date is March 1, 2015. 

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 nationwide.

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.

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 midyear must renew or purchase new coverage for 2015 during the open enrollment period.

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, 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 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

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