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- The individual mandate of the Affordable Care Act requires that each eligible individual get and maintain qualified health insurance
- Every person required to have health insurance has a right to purchase coverage during the annual open enrollment period
- After the open enrollment period, one cannot buy health insurance unless they sign up during an extension or special enrollment period
- After open enrollment, eligible participants may enroll in Medicare, Medicaid, or the CHIP
Having no insurance will cause a tax and penalty under the Affordable Care Act of 2010. The individual mandate requires that every eligible person gets and keeps qualified health insurance coverage. After open enrollment, one can avoid the penalty and tax by gaining a special enrollment, exemption, or using an extension.
After open enrollment, those that qualify by income may get coverage under Medicaid or the CHIP for minors. Comparison shopping will help find the best fit for an individual or family situation.
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The Individual Mandate
The individual mandate provides the legal standard for coverage by the Affordable Care Act. Those not covered after open enrollment as of the first day in January face the possibility of a penalty tax for each month of non-coverage. Those not required to file an income tax return, and those with no taxable income, are exempt from the individual mandate. There are additional exemptions for financial hardships.
The Open Enrollment
The open enrollment is the period set aside for signing up, changing, or renewing policies. It runs from November through the following January at dates announced by the federal government and state exchanges.
The open enrollment for the calendar year 2016 was November 1, 2015, through January 31, 2016.
The government set the open enrollment for 2017; it runs from November 1, 2016, through January 31, 2017. During open enrollment, consumers can compare policies and make informed decisions based on their needs and experiences. They can use comparison shopping to focus on the parts of healthcare plans of greatest importance to them.
They can comparison shop for Medicare plans for which they qualify by age and income.
The ACA Requires Qualified Health Insurance
The core of the ACA reforms of the healthcare industry includes the essential health benefits. A qualified health insurance plan must include the essential benefits. These tests, examinations, laboratory services offer early detection of physical and mental health conditions. Early detection, prevention, and wellness are pillars that support a road to improved health and lower health costs in the United States.
Options After Open Enrollment
The open enrollment is the best time to get insurance. The rule is that after open enrollment, the time to get insurance closes until the next open enrollment. The below-listed items describe the available options for coverage after open enrollment. Consumers can select coverage on the national or state marketplace using comparison shopping to find the best fit.
- Get Medicare coverage; it meets the requirements of the ACA
- Get Medicaid coverage; it meets the requirements of the ACA
- Get CHIP coverage; it satisfies the individual mandate for children and minors
- Sign-up during an extension
- Sign-up during a special enrollment period
- Special enrollment period based on life events, this is a sixty-day period to get insured after open enrollment.
- Extensions add days to the end of open enrollment
- Exemptions reduce or avoid the penalties for not having insurance.
Exceptions, Exemptions, and Special Enrollments
The open enrollment period is part of the Affordable Care Act that changed the way in which Americans purchase insurance. It is the time of the year when everyone can buy insurance, make changes, or renew coverage.
For good reason, the governments can extend the time, offer exemptions to the requirement, and provide special enrollments for those who change status. Some status changes require a new enrollment period such as changing location outside of the current insurer’s territory.
Extensions of the Open Enrollment
The state exchanges and the federal marketplace close at the end of open enrollment. They each have powers to extend the open enrollment when there is some good reason for doing so.
In the past, extensions have helped people that completed partial applications, and people that experienced problems in enrollment such as a system logjam at the end of the scheduled period.
State extensions have covered persons that were blocked by local weather conditions such as floods or power outages.Extensions require an act of the state or federal government to extend the open enrollment period. Extensions may be confined to a state exchange, apply to the national website operated by the federal government at healthcare.gov, or cover all parts of the system.
Exemptions Cover a Lot of Problems
Exemptions include those with temporary financial hardships and those that cannot find qualified policies that cost no more than 8 percent of annual household income.
Exemptions can be short-term such as missing one to two months of coverage or permanent such as a supplemental social security disability rating. Exemptions based on economic hardship may require documentation.
Special Enrollment Periods
The annual process of preparing health plans for consumers, the law permits insurers to use location as a factor in setting prices and services. Along with age and tobacco usage, these are the individual factors permitted in setting prices and arranging services.The ACA uses
The ACA uses special enrollment periods to help subscribers tat change status. For example, a dependent that reaches age 26 can no longer remain on a parent’s policy. This change of status requires a new opportunity to enroll.
The Affordable Care Act uses patient age, tobacco usage, and location to set prices. It also uses the open enrollment period as an element in the pricing of qualified health plans. When an insured must move to a new location, the availability of providers and services must change.Location is a factor that insurers must use when setting rates and services. The
Location is another factor that insurers must use when setting rates and services. The life events follow that line of thought; some status changes require a new opportunity to sign up for insurance. The accepted life events that support special enrollment period include the below-listed items.
- Birth of a Child
- Moving to a new location
- Loss of insurance coverage due to 26th birthday
- Loss of employer-sponsored coverage as an employee
- Loss of employer-sponsored coverage as a dependent
Every eligible person to have coverage on the first day of the calendar year and to maintain it for 12 consecutive months. The government planned open enrollment to coincide with the calendar year. Many people wish to keep coverage and renew a policy. Market changes make it more likely to choose a similar policy.
Getting Coverage after Open Enrollment
Medicaid and the CHIP have no open enrollment limit. Applicants must qualify for Medicare enrollment by age and physical condition. These programs meet or exceed qualified coverage requirements in the Affordable Care Act; they each provide essential health benefits.
Exemptions to Avoid the Penalty
Using an exemption is a good way to avoid paying the individual healthcare responsibility tax. The below-listed paragraphs show the individual shared responsibility payment per year from 2014 through 2106.
– The individual shared responsibility penalty for 2016
For an adult individual – $695, for an individual child $347.50 up to a family maximum of the greater of $2,085 or two and one-half percent of family income.
– The Tax and Penalty for 2015
For an adult individual – $325, for an individual child $162.50 up to a family maximum of the greater of $975 or two percent of family income.
– The Tax and Penalty of 2014
For an adult individual – $95 individual child $47.50 up to a family maximum of the greater of $285 or one percent of family income
The Internal Revenue Service applies the penalty for no insurance. They apply it a 1/12th of the total amount due for each month a resident was uninsured. Another part of this policy forgives one to two months without insurance under a hardship waiver.
The IRS recognizes temporary economic hardships and does not penalize a one or two-month break in insurance coverage.
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