Affordable Care Act, Year 2
New enrollment dates, steeper fines for not insuring

By Greg Grisolano, staff writer

The start of open enrollment for health insurance plans under the Affordable Care Act is just 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 will be the time to purchase coverage or risk paying a tax penalty.

Probably 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.

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, has one piece of advice for those looking for coverage: Don’t put it off.

“What we experienced last year is everybody put off (enrolling) to the last minute,” he said. “It’s going to be even worse this year with penalties increasing to 2 percent of household income. Don’t wait.”

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.

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.

Just like last year, your Association 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.

While last year’s pilot program covered only six states, this year’s program has been expanded to 42. Private insurance exchanges like OOIDA’s are not authorized to sell insurance in New York and New Jersey.

OOIDA’s private insurance exchange is available with multiple carriers, including Assurant, Humana, and most of the local Blue Cross and Blue Shield affiliates.

Brenda Smith, OOIDA Medical Benefits manager, said 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.

“Members will be able to get on there, look at quotes and apply without talking to an agent,” she said. “If you need assistance through this process, you’re going to need to call us.”

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.

The Kaiser Family Foundation offers an interactive subsidy calculator on its website, kff.org/health-reform/, to help determine whether an individual or family may qualify for the tax break.

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. LL