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- The Affordable Care Act provides an annual period for enrollment in qualified health plans; it is called the open enrollment
- Running from November through the following January, open enrollment is the time to add, change, switch, or renew health insurance coverage
- Open enrollment provides a right to buy a qualified health plan that ends with the close of the enrollment period
- After the open enrollment, there are no opportunities to buy qualified health plans unless there were an extension or a special enrollment period
The open enrollment is the preferred time to buy health insurance; the opportunity to purchase coverage ends with the close of open enrollment. The Congress designed the ACA with the idea that everyone would buy insurance during open enrollment. Insurers offer plans both on and off the federal and state exchanges.
Consumers can buy private plans outside of the federal or state exchanges. However, they cannot buy them outside of the open enrollment period. Those that qualify can get covered by Medicaid and CHIP at any time of the year.
Use our free tool to compare health insurance quotes now so you know you’re getting the best price the next time open enrollment rolls around.
Health Plans Based on Time and Location
In its effort to get the best value for consumers, the Congress authorized required health insurance for everyone; companies were no longer able to deny coverage because of prior condition, illnesses, and health. To make this system practical, Congress allowed insurers to base premiums and services on factors like smoking status, age, and location.
They limited open enrollment to help protect the premium and price points so that consumers would have affordable insurance options. For example, if one moves to a different state or different part of the original state, one can qualify for a special enrollment period. Location changes the available insurance choices for the consumer.
Calendar Year 2016 Had an Open Enrollment
The ACA required coverage in the individual mandate runs from the first day of January to the end of the calendar year. Eligible residents must have coverage or face a tax penalty for every month without coverage. The open enrollment period for the 2016 calendar year began on November 1, 2015, and ended on January 31, 2016. During open enrollment consumers could make changes to coverage, including the below-listed actions.
- Renew existing coverage
- Cancel and existing policy and select a replacement
- Switch from one type of plan to another
- Replace an employer-sponsored plan with an affordable marketplace plan
Buying Insurance to Avoid the Penalty and Tax
Every citizen and lawful resident of the US must have health insurance or pay a tax. This rule applies to everyone that is not exempt from the mandate. As a general rule, all those filing tax returns must get health insurance. The penalty for no insurance in 2016 is a tax of $695 per adult, $347.50 per child. The maximum family penalty is the greater of 2.5 percent of household income or $2,085.00.
Buying at State Exchanges or Federal Marketplace
Healthcare.gov is the federal marketplace for buying qualified health plans. It operates in place of state exchanges for the states that refused to establish and operate exchanges. The states that adopted the Affordable Care Act each up a separate state-based health insurance exchange. When using either type of website, the trained personnel will refer those that fail to qualify for ACA plans to the state agencies for further review and assistance. This assistance includes CHIP and Medicaid.
Consumer Options After Open Enrollment Ends
Those who fail or don’t attempt to qualify for an ACA health plan, may be eligible for Medicaid or CHIP. These healthcare programs satisfy the individual mandate for required insurance coverage. The Medicaid program and CHIP have continuous open enrollment.
These are excellent options for those who miss the health insurance open enrollment. Medicaid has an income limit for participation and CHIP has an age limit.
The Children’s Health Insurance Program provides dental and health care for low-income children.
Medicaid provides health care for adults that cannot afford ACA qualified health insurance coverage. In states that expanded Medicaid, the income limit is higher than in states that declined this funding.
Special Enrollment Periods
The Affordable Care Act provides for life events that affect status. These changes are so basic that the rules allow a new enrollment period. Some life events affect coverage such as moving to a new location where an existing provider may not offer services. Other changes go to the personal status such as divorce or marriage that may require a new type of coverage.
Life Events Get Special Enrollments
The rules provide a sixty-day window for getting new insurance coverage after the occurrence of a life event. Life events include the below-listed changes in application status.
- Birth of a child
- Loss of employment-sponsored coverage as an employee
- Loss of job-related coverage as a dependent
- Loss of coverage as a child dependent, or minor(turning age 26)
- Moving to a new state, location, or zip code
When using a special enrollment period, consumers can use comparison shopping to quickly find the features of most concern or the most important benefits.
Federal and State Governments Announce Extensions
Both the federal and state governments can extend open enrollment. They had done so when fairness required it such as when automated systems failed or the unexpectedly high numbers of applicants left thousands of incomplete applications.
Some extensions exist only for completing partial applications or to compensate for weather problems that could have prevented more registrations.
While these occur typically when there are system backlogs and downtime, they can occur for other reasons and consumer that need more time should ask. Both the state and the federal governments have the authority to extend the time for open enrollment and to set conditions for participation in the extension periods.
Open Enrollment is Important
Open enrollment is an important time for consumers. They can research available options for health services and medical care. With an understanding of actual or foreseeable needs, they can select health insurance coverage that minimizes out-of-pocket costs, and maximizes insurance paid benefits. They can use comparison shopping techniques to compare plans and gain the best advantages for their individual or family situations.
Four Types of Plans
All of the plans sold on the federal marketplace and state exchanges meet the requirements of the law for providing the ten essential health benefits. Plans grouped by metal tiers to help consumers compare features and make the best choice for their needs.
The common base for each type is the value of the plan as determined by the amount of insurance paid benefits. They range from a high end of ninety percent for Platinum to the low end for catastrophic coverage. The features of the plans can be quite different; the common thread is the amount of insurance paid benefits.
Metal Values Provide a Consistent Approach
The below-listed metal bands describe the four types of ACA plans. When selecting plans, many consumers get greater benefit from comparison shopping. This method permits consumers to decide which features are most important and to rank their options by those important features. For example, if saving out-of-pocket costs is most important, then consumers can search to see if the services they need have co-payments or cost more because of out-of-network.
The ACA Offers Four Levels of Qualified Health Plans
The essential health benefits are the basis for grouping plans in the ACA system of metal tiers. These services make-up the necessary parts of a qualified health plan. They include prevention and treatment services.
- Platinum plans cover about ninety-percent of benefits with insurance payments, and this leaves about ten percent of consumers. Platinum plans have high premiums and low out-of-pocket costs and deductibles.
- Gold plans provide about eighty percent insurance paid benefits; these plans have high premiums and lower deductibles and out-of-pocket expenses than the silver and bronze tiers.
- Silver plans pay about seventy-percent of costs for benefits. This portion leaves about thirty percent for the consumer. Silver plans also work with payment assistance for costs savings, and consumers can add health savings plans for maximum flexibility.
- Bronze plans have about sixty-percent insurance paid benefits and forty percent left to the policyholder. These plans offer the lowest range of premium costs but also have the highest range of deductibles and out of pocket expenses.
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