Open enrollment underway for Affordable Care Act

By Greg Grisolano, Land Line associate editor | Friday, November 04, 2016

The open enrollment period for health insurance under the Affordable Care Act starts now.

Those who purchased insurance through a public marketplace will have the opportunity to shop for new coverage, while those who are still without insurance will have their best chance to find a plan that’s right for them or risk paying a fine on next year’s taxes.

For 2017, the open enrollment period began Nov. 1, and runs until Jan. 31, 2017. It’s also crucial to remember that your enrollment date is not the same as your effective date. For example, if you enroll between Dec. 16, 2016, and Jan. 15, 2017, your coverage starts Feb. 1, 2017. If you enroll between Jan. 16, 2017, and Jan. 31, 2017, your effective date is March 1, 2017.  

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 do not enroll in a qualifying plan during the open enrollment period will be unable to purchase health insurance in 2017 unless they have a qualifying event such as loss of job, marriage, divorce, birth of a child, or moving to another state.

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.

A recent report from the Kaiser Family Foundation predicts that the average monthly insurance premium for the lowest-cost and second-lowest-cost Silver plans will increase 9 percent, to $288 on average for a 40-year-old non-smoker, prior to tax credits. The Silver plans are considered the benchmark that the federal government uses when establishing federal premium subsidies, and typically are the most popular plans chosen on the marketplace. Of the 16 states and the District of Columbia that were analyzed in the foundation’s report, the number of insurers in each state is expected to decline slightly on average, but be still in line with 2014 levels.

Not having health insurance could cost you at tax time. In 2016, the penalty for not having an ACA-compliant insurance plan or forgoing coverage altogether was the greater of either $695 per adult plus $347.50 per child or 2.5 percent of family income in excess of the previous year’s income tax filing thresholds. The penalty is capped at an amount equal to the national average premium for a Bronze plan, which is the minimum coverage available by law. In 2016, that cap was $2,085 for a family. Beginning in 2017, the flat fee portion of the penalty will be indexed to inflation. Fees are paid as a part of the filing process for federal income tax returns.
 
Due to significant changes to the health care insurance marketplace that were brought about by the ACA, the Medical Benefits Group at OOIDA will no longer offer individual major medical coverage to Association members. The Medical Benefits Group at OOIDA is working on a Minimum Essential Coverage (MEC) plan as well as Voluntary Hospital Indemnity Insurance, which can be purchased with a MEC plan. Look for details in an upcoming issue of Land Line.

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 HealthCare.gov

Consumers with questions are encouraged to contact the HHS call center at 800-318-2596 or visit the website above to 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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