Open enrollment for health insurance under the Affordable Care Act officially began Nov. 15; consumers must enroll by Dec. 15 in order to have coverage beginning Jan. 1.
Open enrollment is open Nov. 15 through Feb. 15, 2015. If an individual enrolls by the 15th of any month between now and February, their coverage would begin on the first day of the next month.
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act, also referred to as the Affordable Care Act, or Obama Care, that was created by the California Department of Health Care Services for individuals and small businesses to purchase health insurance plans. The marketplace offers plans from up to 10 companies.
The marketplace, however, acts as a shopping mall of sorts to obtain coverage, it is not, as many believe, solely an avenue of obtaining government-subsidized insurance. Although health insurance can be subsidized, life insurance can not and people will need to source their own life insurance. Thankfully, there are sites such as www.discountlifecover.co.uk that make it easy to take out a life insurance policy.
However, many can qualify for federal subsidies to lower their cost of coverage, depending on their household income. There are no annual limits on how much a plan will cover, and each plan has standardized benefits and free preventive care. Additionally, Californians in need of health insurance cannot be legally denied coverage.
The system helps individuals determine their eligibility for assistance available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal, so long as all information is properly inputted.
The online marketplace can be difficult to navigate, so going through a health insurance broker is free and has the potential to make the process smoother for individuals seeking to obtain health insurance regardless of insurance provider or level of federal subsidies they might qualify for, including Medi-Cal.
Local insurance brokerage, Western Valley Insurance, has staff members devoted to assisting individuals with enrollment and the many nuances that may make enrollment difficult.
“The difference is having a professional who can guide them through the process,” said Vickie Medeiros of Western Valley Insurance. “We can take what would be a four hour process for them and make it a 20 minute process if we’re doing it with them.”
In the event that an individual had an issue with the plans they enrolled in, for example, insurance cards were not received, or an issues with payment arose, the health insurance broker would work to resolve issues on the behalf of the client, instead of the individual having to do it on their own.
“We get to counsel or advise you on what you’re picking, and you pay the same price,” said Tyler Flaherty of Western Valley Insurance. “We’ll get to do a lot of the work for you, guide you through it.”
Consumers, on their own, or with the help of a broker, can compare health insurance plans and choose the plan that works best for their situation. Small businesses can buy health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.
“We also know the carriers and provider networks which is the biggest distinction. Instead of them spending a lot of time doing that research, we can help them with that and make it an easy process,” said Medeiros.
The only way to get health care outside of the enrollment period is to have a “qualifying life event” such as turning 26, the cutoff age for staying on parents health insurance plan, getting married, having a child, losing or obtaining employment. A qualifying event would grant an individual a “special enrollment period” of 60 days to enroll in new health coverage.
Because no one can be denied coverage under the federal mandate for care, individuals must pay into their plans, both when they are in need of care and when they are not. Potential implications of a system with no enrollment periods would lend to individuals enrolling and canceling insurance plans care was needed.
If an individual does not obtain health insurance, they face a tax penalty which increases yearly; penalties are incurred by tax year, meaning that even if an individual enrolled in a health insurance plan before the Dec. 15, 2014, with no prior coverage, they would still incur a penalty for that tax year because coverage would begin Jan. 1, 2015.
Health insurance subsidies are offered to individuals as a pre-tax credit, meaning, according to the information an individual submits regarding their household and income status, they are deemed eligible for certain credits which are applied to the plan they enroll in, co-dependent on their income tax filings. Instead of the consumer receiving a tax credit when they file income taxes, it is applied to the rate of insurance.
If an individual makes more money than they report when enrolling in insurance, they are subject to paying offered tax credits back when filing their federal income taxes. Conversely, if an individual ends up earning less than they anticipated, or an event occurs that would contribute to a change in subsidies they would be eligible for, they would receive an increased tax credit upon filing.
Covered California anticipates a total enrollment of approximately 1.7 million Californians, excluding Medi-Cal enrollees, by the end of the second open-enrollment period: 1.5 million in subsidized coverage and 230,000 in unsubsidized coverage. This forecast represents an increase of about 500,000 in total enrollment.
Important dates to remember for individuals seeking health insurance:
Dec. 15, 2014: The last date to enroll for coverage that starts Jan. 1, 2015
Dec. 31, 2014: Date when all 2014 Marketplace coverage ends, no matter when you enrolled
Jan. 1, 2015: The date 2015 coverage can start if you apply by Dec. 15, 2014, or if you accept automatic enrollment in your 2014 plan or a similar plan
Feb. 15, 2015: The last day to enroll in 2015 coverage. If you miss this deadline, you cannot sign up for a health insurance plan inside or outside the Marketplace for the rest of 2015. The only exception is if you qualify for a Special Enrollment Period.
For assistance locally in enrolling in health insurance coverage before the enrollment period ends, you can contact an independent broker, like Western Valley Insurance in Turlock, or visit Covered California’s website.