Obamacare Open Enrollment for Health Insurance Coverage

Open enrollment for federal and state health insurance marketplaces began on Saturday, November 15. Whether you’re one of the 8 million people who enrolled in a health insurance plan through the Patient Protection and Affordable Care Act (“the ACA”) — Obamacare — in 2014, or this is your first time exploring the marketplace, you’ll need to take a few things to ensure that you and your family have the health coverage you need for 2015. Here’s what you need to know about enrolling in the 2015 health insurance marketplace.

During open enrollment, you can enroll for the first time, change your plan it you’re not getting what you need, and update your information – possibly lowering your premiums. The federal website Healthcare.gov is the gateway to the federal healthcare marketplace.

If you have trouble (even though the website is better than during the 2014 enrollment period, it’s not foolproof), call 1-800-318-2596 to reach a representative who can help. TTY users should call 1-855-889-4325. Local help is also available through brokers and navigators (they often work for health systems, community health centers, and local governments or non-profit agencies). EnrollAmerica is a national non-profit organization that assists with eligibility and enrollment, as well.

How to Renew or Enroll

Even if you’re already enrolled and you’re happy with your current plan, you need to update your information. Because subsidies and premiums are tied to income, age, and other factors, you’ll need to go online to update any information that might affect your premiums and benefits. If you do nothing and you’re already enrolled in a plan, you won’t lose your coverage – but you may see some unexpected changes in your coverage.

If you didn’t sign up for health insurance during the 2014 enrollment period, you can follow the same steps listed below, but set aside extra time to enter your information into the website.

Nice to Know: What about Medicaid?

If your income is lower than 138% of federal poverty level (FPL), you may be eligible for Medicaid, the federal-state health coverage program for low-income Americans, especially if you live in a state that chose to expand the program. That means that you can make up to $16,105 ($32,913 for a family of four) and still qualify. If you live in one of the 23 states that chose not to expand Medicaid, the threshold is generally between 60% and 133% of federal poverty level, and other restrictions apply. If you are low-income, your options for coverage depend on your income:

  • If your income is more than 100% of FPL ($11,670 a year for a single person or $23,850 for a family of 4), you can purchase a plan in the marketplace and may be eligible for premium tax credits and other savings based on your household size and income.
  • If your income is less than 100% of FPL, however, you won’t be eligible for help paying for private insurance. Still, you should apply for Medicaid, since you may qualify under your state’s existing rules. But if you aren’t eligible, you are one of approximately 9 million adults who fall into what is called the “coverage gap:” Your income is too high for your state’s Medicaid eligibility rules but too low to qualify for subsidized insurance under the ACA.

Here’s a five-step plan to health insurance coverage that works for you:

  • Step 1: Review your plan. You may be happy with your plan, but your insurer may have changed important details. Premiums, or how much you pay each month, may change. They may have changed the cost-sharing rules, which include deductibles (how much you pay out of pocket before your insurer begins to pay), co-pays (a set amount that you pay each time you visit a health-care provider), and co-insurance (that’s when you pay a percentage of a certain service – for instance, if you have a 5% co-insurance rate for diagnostic testing, you would pay out of pocket for 5% of the cost of an MRI). Benefits and services may also change. Review the plan your insurer is proposing for 2015 and make sure it’s the right one for you.
  • Step 2: Update your information. Make sure your information is accurate and up to date. Log on to your Healthcare.gov account, then review the pre-filled information to ensure it’s still accurate.
  • Step 3: Shop around. Take some time to compare your current plan to other available plans. New insurers are entering the market, while established vendors are changing their benefit offerings for 2015. You may find a better package if you spend a little time shopping. Here are a few things to look for in your plan:
  • How much is the premium (monthly payment)?
  • How much is the deductible?
  • How much is the co-pay for office visits, hospital stays, and emergency room visits? What about ambulance services?
  • How much is the co-insurance for procedures such as imaging or surgery? 
  • What is the maximum out-of-pocket cost?
  • Will your prescriptions be covered?
  • What other benefits are included?
  • Step 4: Choose. After you’ve reviewed the plans available to you, it’s time to choose the one that most closely fits your needs. Don’t be afraid to call or ask for help.
  • Step 5: Enroll. Complete your enrollment by and December 15, 2014 to ensure your coverage starts by January 1, 2015. Although open enrollment lasts until February 15, 2015, you may have a gap in coverage if you wait. Check with your insurer to find out when your coverage starts if you enroll after December 15.

What if I Opt Out?

You can certainly opt out of the whole insurance thing, but if you do, you should know what to expect. Most people who choose not to enroll will have to pay a penalty. If you didn’t enroll in 2014, you’ll pay $95 per adult or 1% of your household income, whichever is greater. If you choose not to enroll in 2015, the penalty per adult will be $325 per adult or 2% of your household income. More importantly, you won’t have health coverage should you get sick — and funding for care for the uninsured (“uncompensated care”) has been dramatically reduced. 

Some people qualify for an exemption. You might qualify for an exemption if you were uninsured for less than three months out of the year, the cheapest plan available to you costs more than 8% of your household income, or if you didn’t earn enough to file a tax return for 2014. There’s also a hardship exemption for people who are homeless, victims of domestic violence, or those who experienced other extenuating life circumstances during the year. A religious exemption is available for members of recognized religious sects with religious objections to insurance, including Social Security and Medicare.

Image Copyright: jackf / 123RF Stock Photo


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