Affordable Care Act Open Enrollment Deadline Approaches

December 16, 2015

Published 12/16/15 by Marisa Vertrees

While you’re doing your online shopping for holiday gifts, don’t forget to shop for health insurance as well!  The open enrollment period for the Affordable Care Act opened on November 1, 2015.  If you want to be covered by January 1, then you must enroll by Tuesday, December 15.  UPDATE: The deadline was extended through the end of the day on Thursday, December 17th.

If you miss the 15th 17th, don’t fear.  You can continue to register as part of the open enrollment period through January 31st, but you risk being without insurance for one or two months as your coverage won’t begin until February 1st (if you register by Jan. 15) or March 1st (if you register by Jan. 31).

Don’t get penalized for not having insurance.  In 2016 the fees for not having coverage go up to whichever is higher: $695 for an adult and $347.50 for a child under 18, or 2.5% of the household income, which is billed when you file your 2016 taxes.

This can be confusing, though, so below are some answers to questions you may have about open enrollment:

1. Who is required to have insurance?  Every US Citizen is required to have insurance, whether it’s through your employer, Medicaid, Medicare, the private market, or a health care exchange.  The only exceptions are if:

        a) Your religion forbids you from getting healthcare (ie, you are Amish)

        b) You are currently incarcerated

         c) You are a member of a recognized American Indian tribe

        d) You do not need to file a tax return

        e) Insurance would be a hardship—this is formally agreed upon if
             insurance would be more than 8% of your income, but you can
             claim other hardships as well

2. What exactly are these exchanges?  The health care exchanges are what people are usually thinking of when they talk about Obamacare.  These are run either by your state or, more likely, the federal government.  They allow an individual or family to purchase insurance, and will have a number of providers.  Each state has different companies and insurance options, but every exchange will offer different options based on a “metal level” starting with the most basic, bronze, through silver, gold, and platinum, the most expensive health care options.  They were designed to make it easier for individuals without access to employer insurance coverage to still locate and purchase affordable insurance.  While states and the federal government manage these plans, which have to meet certain standards and be open to anyone who wants to purchase one, the plans themselves are through the insurance company.  It is NOT “socialized medicine” run by the federal government.

3. Who can purchase insurance on the State and Federal Exchanges?  Everyone can purchase insurance on the exchanges!  Even if your employer offers insurance, you can still purchase from the exchanges if you can find a plan you prefer.  However, that doesn’t mean you will qualify for subsidies. 

4. What are the subsidies?  And who qualifies?  If your employer does not offer qualifying insurance, and you make under 400% of the poverty line ($97,000 for a family of four), you could qualify for subsidies. To find out for sure, you can do a quick check through the ACA website.

5. What if I don’t get insurance by the deadline?  If you don’t get any form of health insurance by the Jan. 31st deadline, and you’re not in one of the exempt groups (and if you’re reading this you’re probably not Amish….) you’ll pay the penalty.  The only exception is if, before March 31st, you can find alternate insurance or have a “qualifying life event,” such as a baby, marriage, or divorce, that allows you to purchase insurance.  The real penalty, though, is that without insurance you’re likely to ignore standard and preventive health care, such as well visits and cancer screenings, that would be covered by insurance.  And without insurance you could be faced with high costs for any emergencies you have or conditions you develop throughout the year.

6. I’m still a bit confused.  There’s a lot to it!  But what it boils down to is, if you have insurance through your job, you’re fine.  If you don’t have insurance, you need to get it, through an exchange or otherwise.  And there are lots of health care connectors who can help you explore the health care exchanges and your options.  You can find one in your area here.

So be sure to register for health insurance, take preventive care measures, and check out the Prevent Cancer Foundation’s tips on staying healthy

To stay up to date on this and other issues, become a Prevent Cancer Advocate

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