#1 If you want health insurance for 2016, you have to enroll between November 1st and January 31st. For 2015, there were a couple of extensions added on, but there is no guarantee there will be any extensions this year. If you do not enroll in health insurance during open enrollment, you will not be able to purchase health insurance mid year, unless you are within 60 days of a Qualifying Life Event. For a list of qualifying life events see our past blog article. You also cannot make any changes to a policy mid year without a qualifying life event. This means that you need to try to plan ahead for 2016. While we can't predict how often we will get sick, or whether we will be injured, there are things that we can try to plan for. Are you going to be pregnant, or having a baby in 2016? Is there a major procedure that you will need done within 2016? While shopping for a health plan for 2016, keep these factors in mind. You may want to pay a little more in premium to save you from having to pay a large deductible. I can't tell you how many people I've talked to this year that were not aware that they couldn't enroll in health insurance until open enrollment. Don't put this decision off until the last second. Choosing a health insurance plan is an important choice, and there is now limited time to make a choice.
#2 If you are in a "grandfathered plan", you cannot make any changes to your health insurance. A "grandfathered plan" means that the plan was in effect before the ACA was signed into law. President Obama had promised that anyone who wanted to keep the plan they were on prior to the ACA, would be able to keep it without changes to their benefits or premiums. Initially this did not happen, but upon being reminded of this promise, President Obama negotiated to have this brought about. However, if you make any changes to the plan, such as dropping one of your children off of your family plan, the insurance company is not required to continue providing that plan at the cost pre-ACA. In many cases, this means the premiums will double in cost for the same benefits you had before. If you have one of these plans, you need to be aware of the consequences of making any changes to the plan.
#3 Lawfully Present Immigrants are eligible to purchase health insurance on the Marketplace. Many immigrants that are in the U.S. legally are eligible for federal subsidies when purchasing health insurance. This includes people that have a "Green Card", or Lawful Permanent Resident status. Refugees and people that are in the U.S. that have been granted asylum can also purchase health insurance on the Marketplace. Also, people that have a work visa or student visa are eligible for federal subsidies. If you are a documented immigrant in the United States, then more than likely, you can enroll in health insurance through healthcare.gov. For a full list of eligible immigrants, click here.
#4 Everything depends on your taxes for 2016. The main idea is your estimated income for 2016 will decide what your premiums for health insurance for 2016 will look like. If you are interested in getting a federal subsidy to help cover the cost of your health insurance, then you will need to make a guess as to how much you think that you will make in 2016. If you're married, you will need to use your estimated combined income. You will also be asked how many people you will file on your tax return for 2016. Its a lot like filing for Medicaid. The government has decided how much income is required to support a family of 3 members, 4 members, 5 members, and so on. If the income is within a certain range, then you will qualify for a subsidy. However, you can make too much money for a subsidy, and you can make too little money for a subsidy. The difference can be as little as $1000 a year, so you can fiddle around with your projections a little and see a big difference in your premiums. If you make too little money for a subsidy, they will recommend that you enroll in Medicaid. I won't get into the "black hole" right now, for more details on that issue, see our past blog article.
If you find that you are on the edge of being eligible for a subsidy(and you want/need that subsidy) you can adjust your projections to get that subsidy, and then you will simply have to make sure that you don't make more or less money in 2016 than your projection. Any change in your income, whether you get a new job, get a raise, or lose your job, should be reported to the Marketplace, and they will adjust your premiums accordingly. A key concept of health insurance has changed from the ACA: you are no longer rewarded for being healthy and not filing many claims with lower premiums. How much you pay for health insurance is directly based on how much money you make in a given year.
#5 If you do not enroll in health insurance for 2016, you will be penalized on your taxes for that year. For 2015, the penalty for not having health insurance will be either 2% of your annual family income, or $325 per person($162.50 for children under 18) for the year, whichever is higher. You will see this charged to you in taxes, or subtracted from an return you may be eligible for. For 2016, the tax penalty will go up to 3% of your annual income. This percentage is only taken on the amount of your income above the tax filing threshold for your bracket. The penalty will continue to increase each year. Many people will notice that the penalty is still far less than what they would pay in premiums for the year. However, going without health insurance is a very risky decision sickness and accidents are unpredictable and can cripple you financially in a very short time.
Health insurance is tricky at best, and the ACA does not make things any simpler. If you have questions about how Obamacare will affect you, feel free to call the office, or email me. Get ready for Open Enrollment folks! Its coming up fast!
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