Affordable Care Act Open Enrollment enters final month

By Greg Grisolano, Land Line staff writer | Wednesday, January 14, 2015

The deadline for open enrollment for health coverage under the Affordable Care Act is right around the corner. 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.

While the final day for enrollment is Sunday, Feb. 15, Association members who wish to purchase a plan through the OOIDA’s Members Healthcare Exchange or who have questions they wish to have addressed by an insurance professional must do so by Friday, Feb. 13, since the office will be closed for the weekend.

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 as your effective date. For example, if you enrolled in coverage on the first day of the open enrollment (Nov. 15, 2014), your policy became effective on 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. 

The ACA mandates enrollment in a qualified health insurance plan for most Americans. For those not exempt by law, failure to do so will result in a penalty assessed on your federal income taxes. The tax penalty is increasing to 2 percent of your yearly household income for not enrolling in a qualified plan during 2015.

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.

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 40 states. By law, private insurance exchanges 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 who have VA medical care; 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.

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.

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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