Affordable Care Act Year 3: Open enrollment starts now

By Greg Grisolano, Land Line associate editor | Tuesday, November 03, 2015

Don’t have insurance or want to shop for a better plan? Now’s the time. The open enrollment period for health coverage under the Affordable Care Act is happening now. 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.

For 2016, the open enrollment period began Nov. 1, and runs until Jan. 31, 2016. With that cutoff, this year’s open enrollment period will end two 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. 1, 2015), your policy becomes effective on Jan. 1, 2016. If you enroll between Dec. 16, 2015, and Jan. 15, 2016, your coverage starts Feb. 1, 2016. If you enroll between Jan. 16, 2016, and Jan. 31, 2016, your effective date is March 1, 2016. 

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.

Due to significant changes to the health care insurance marketplace that were brought about by the ACA, the Medical Benefits Group at OOIDA has a limited number of states where it can offer major medical coverage to Association members. As the market changes, so could the availability of coverage in these and other states. The Medical Benefits Group will continue to assist OOIDA members with obtaining coverage in certain states and will be available to offer advice and guidance to members in general.

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 2.5 percent of your yearly household income for not enrolling in a qualified plan during 2016. The maximum penalty is the national average premium for a Bronze insurance plan. Fees are paid as a part of the filing process for federal income tax returns.

One of the ways in which the ACA attempts to make health insurance more affordable is by offering tax subsidies to qualified individuals who purchase insurance through state or federal exchanges. Those applying for subsidies must fall between 133 percent and 400 percent of the federal poverty level in order to qualify.

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 who live in states that have not expanded Medicaid programs and would have qualified for Medicaid under the expanded coverage.

For a full list of exemptions and information on how to file for one, visit the HealthCare.gov website.

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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