Now through Jan. 31, 2017, Americans who don’t have health insurance through their employer, have an Open Enrollment period when they can choose or change a health insurance plan and find out if they qualify for subsidies to reduce the monthly premiums.
It’s important to review your options because you may be missing a subsidy or tax credit you didn’t know was available. About 85 percent of Americans can qualify for a subsidy to help pay their monthly premiums. But, they have to buy a plan from the healthcare.gov insurance marketplace, rather than on the open market where they will pay full price. More than 9 million Americans are currently receiving subsidies through the Health Insurance Marketplace to keep health insurance coverage affordable. Under the Affordable Care Act, or Obamacare, if your income is below $97,200 a year for a family of four (or about $47,000 for an individual) – you will qualify for a subsidy. The lower your income, the larger the subsidy.
Most consumers returning to HealthCare.gov will be able to find a policy with a monthly cost of $50 to $100. More than 70 percent of consumers can find a plan for less than $75 a month, taking into account the subsidies available.
Because tax credits increase dollar-for-dollar with the cost of the plan, the majority of consumers will be protected from rate increases.
In addition to the subsidy increases, shopping for a plan can also help keep premiums low. For example, if returning consumers selected the lowest-cost plan with the same metal level (gold, silver or bronze) they chose last year, average premiums would fall by $28 per month – or 20 percent less than in 2016. So it pays to shop, even if you’re happy with your current plan.
No insurance? Penalties increasing
If you choose not to have health insurance, you could pay a hefty penalty this year. For 2016, people without any health insurance coverage, and who are not enrolled with their employer (or spouse’s employer), or in Medicare, Medicaid, Tri Care for veterans or ARKids A or B, will have to pay about $700, or 2.5 percent of income. Families with higher incomes will pay a much higher penalty because of the 2.5 percent of income rule. Every year this penalty will increase.
There are a number of exemptions to the penalties for not having a health insurance plan. Most apply to people with very low incomes.
These penalties are imposed to encourage all Americans to take responsibility for their health by locking in some type of insurance coverage. Even if you’re healthy and rarely use health insurance, you need to pick a policy. When everyone is enrolled, we all save.
How to apply
There are many affordable plans available on the Marketplace at HealthCare.gov. All consumers will be able to choose among plans with different combinations of premiums, out-of-pocket costs, networks of hospitals and doctors, and prescription drug coverage. Every plan in the Marketplace offers the same set of basic but essential health benefits, such as doctor visits, prescriptions, preventive care and more. You can also get an estimate of your total costs under different health plans, by estimating the level – high, medium or low – of medical services you expect to need in 2017. Compare plans based on what’s important to you.
Applying for health insurance is fairly simple and free help is available if you need it. You cannot be charged a fee for enrolling and no one can charge for helping you get enrolled.
Before you start the shopping or application process, you’ll need to gather some basic information about each person in your household, including anyone you claim as a dependent on your tax return, even if they’re not applying for coverage. You’ll need their tax return (if they file separate from your return), address, birth date, Social Security number and current health coverage policy number. You’ll need to know if anyone has been offered coverage through their employer. Legal immigrants will need to provide some information from their immigration documents. If you/family members currently have coverage, you’ll need current plan identification numbers for each member of your household. You’ll also be asked to estimate your household income for next year.
There are several ways to apply:
- Many people prefer the ease and convenience of applying and enrolling online at HealthCare.gov. You can find the most accurate information about the Marketplace at this site. You can also shop for plans, review costs and complete your application for a plan at this site. The results you select will be listed in order of price – least expensive to most expensive. You can also have plans ranked by the deductible, or amount you have to pay up front before the insurance begins to pay. After you shop and compare plans, you will be guided through the application process. If you want to think about your options and apply later, go to HealthCare.gov/get-coverage/ (and select your state) to actually enroll.
- Call the Marketplace Call Center toll free at 1-800-318-2596 (TTY users call 1-855-889-4325). Telephone support is available 24/7.
- To apply in person or if you need help understanding your coverage options, contact a trained “navigator” or certified application counselor. These government-trained navigators provide unbiased information. They will explain your options, answer your questions and help you apply for the plan you choose. They are not allowed to pick a plan for you. To find an objective navigator near you, visit https://localhelp.healthcare.gov.
- To apply in person, you may also contact a private insurance agent or broker. They will help you understand your coverage options. They are allowed to suggest a plan for you.
Remember, even if you currently have a Marketplace plan, you still need to compare plans and prices for 2017. Many people are automatically re-enrolled for 2017 in their 2016 plan. But, you can still shop and change plans during open enrollment.
If you’re choosing a new plan, be sure you can keep your current doctors, hospitals and other health care services, if that’s important to you. Switching plans does not guarantee you will have the same health care providers or facilities.
To have your coverage start Jan. 1, 2017, you’ll need to enroll no later than Dec. 15, 2016. If you wait and don’t sign up until Jan. 15, 2017, your coverage won’t start until Feb. 1, 2017. If you sign up by Jan. 31, 2017, your coverage won’t start until March 1, 2017. Even after you’ve completed your application, you can still make changes until Jan. 31, 2017.
After Jan. 31, 2017, you cannot sign up for coverage until the next open enrollment period Nov 1, 2017 through Jan. 31, 2018. Your coverage wouldn’t start until 2018 – and you would incur more penalties for not having coverage. There are exceptions to this rule (called a special enrollment period or SEP) for people who have had certain life events that cause a change in family status, such as marriage or the birth of a child. Also, if you have lost other health insurance coverage, you have the right to sign up for another plan during the 60 days following the loss of previous coverage. If you have a new job and get insurance through your employer, then you must be allowed a SEP of 30 days.
Exceptions for other enrollment
If you get your health insurance through your employer, the options above are not available to you. Employees who use their employer-sponsored health plans receive similar Marketplace “subsidies” or cost breaks from their employers.
If you have a low income and qualify for Medicaid, the Private Option (to be called Arkansas Works starting in January) or Children’s Health Insurance Program (CHIP), there are no deadlines to enroll. You may enroll at any time by contacting the Arkansas Department of Human Services (DHS) county office in the county where you live.
Having health insurance brings peace of mind by knowing you’ll have coverage for regular health care, emergencies, free preventive care, or for chronic conditions such as diabetes or heart disease. The deadline for sign up is Jan. 31, 2017.