The next open enrollment period in which individuals can buy health insurance policies on and off the health insurance marketplace runs from Nov. 15, 2014 to Feb. 15, 2015.
“If you do not purchase a plan within this period, you may be barred from obtaining health insurance coverage until 2016’s open enrollment, unless you have a ‘qualifying life event’ throughout the year,” says Douglas Fleisner, sales executive, JRG Advisors.
Some examples of a qualifying event are birth, marriage, divorce, losing current coverage, certain changes in your income and moving to a new state or area where different medical plans are available.
Smart Business spoke with Fleisner about what individuals need to know about the open enrollment process.
What primary concerns should people be aware of regarding open enrollment?
Those who experience a qualifying event will have 60 days to apply for coverage. If they fail to do so, they will have to wait until the next open enrollment period to enroll in a plan.
If they go without qualified minimum essential medical coverage for all or part of 2015, they may be subject to an individual mandate penalty. This penalty increases in 2015 to $325 per adult or 2 percent of the modified adjusted gross household income, whichever is greater.
Qualifying medical coverage can include coverage provided by an employer, health insurance purchased in the health insurance marketplace, most government-sponsored coverages and coverage that is purchased directly from an insurance company.
However, qualifying coverage does not include coverage that may provide limited benefits, such as coverage only for vision care or dental care, workers’ compensation or coverage that only pertains to a specific disease or condition.
Can people shop somewhere other than www.healthcare.gov?
There are many options for individuals looking for coverage both on and off the health insurance marketplace.
The first step people should take when shopping for individual coverage would be to see if they and/or family members qualify for a premium tax credit through www.healthcare.gov. They may qualify if their adjusted gross household income falls between 100 to 400 percent of the federal poverty level (FPL).
If their income is below 250 percent of the FPL, they may even qualify for cost sharing reductions, which provide them with a richer benefit health plan than if they purchased one outside the marketplace. Advance payments of the tax credit can be used right away to lower monthly premium costs.
If the amount of advance credit payments received for the year is less than the tax credit that is due, they will get the difference as a refundable credit when they file their federal income tax return. If advance payments for the year are more than the amount of the credit, they must repay the excess advance payments with their tax return.
In order to qualify for a subsidy or cost sharing reductions, a person must be a citizen or non-citizen lawfully present in the U.S., reside in the state covered by the exchange and not be claimed as a tax dependent by another taxpayer. An individual cannot be eligible for health insurance through an employer group program that is deemed affordable and provides minimal value under the Affordable Care Act (ACA), and cannot be eligible for any government-sponsored program such as CHIP, Medicaid or Medicare.
How else can a person be prepared?
It is important to look at all options available, make sure the window to enroll in a plan isn’t missed and avoid the individual mandate penalty. It is important that individuals have a clear understanding of the requirements mandated by the ACA. It may also be helpful to consult with an insurance specialist who is certified to help individuals both on and off the government marketplace.
A certified insurance professional can ensure that an individual is selecting an insurance plan that best meets their financial, medical and network needs.
Insights Employee Benefits is brought to you by JRG Advisors