The Affordable Care Act’s Open Enrollment Period had a tumultuous and confusing beginning. In addition, several last minute changes in applying the law left many scrambling to understand their options after December 2013. Here are seven things that you need to know and are still true now that the New Year is upon us:
- Insurance can be purchased in the Healthcare Marketplace (“On the Exchange”) to receive help paying your premiums and other costs. You can purchase On-Exchange plans if you are not eligible for qualifying, deemed affordable health insurance at your workplace. To be eligible to receive advance tax credits (subsidies) toward your premium costs you must purchase an On-Exchange policy.
- Private insurance carriers are the providers for the Healthcare Marketplace and they provide private “Off Exchange” healthcare policies as well. Anyone (even those who have an option of workplace coverage) can choose to purchase insurance privately from these carriers. The same time periods of Open Enrollment apply.
- Enrollment is still on-going. According to law, individuals and families who are not already covered at work will have until March 31, 2014 to purchase qualifying health insurance plans for coverage in 2014 and avoid a penalty. More on the Shared Responsibility Provision Here
- Enrolling is different than being covered. Although exceptions were made in December 2013 to accommodate for government website problems, generally, applications that are made by the 15th of the month will be issued on the 1st day of the following month. So, waiting until March 31st will give you an insurance policy as of May 1st, 2014.
- All qualifying health insurance policies will be issued regardless of pre-existing conditions. Your health conditions will not affect your premium. There are no premium differences for males or females, but carriers are permitted to require higher premiums for smokers. Premium rates will also be different depending on your age group, but the law restricts the range of premiums allowed for the age groups. (This has the effect of generally lowering the rates for those in the older age bracket, while those in the younger brackets may see a higher premium than they were accustomed to under pre-reform actuarial rating systems.) See more on the Essential Benefits that are included in policies Here
- The law defines when insurance can be purchased, with some exceptions. Those who do not meet the March 31st deadline and do not meet other hardship requirements, or do not experience a qualifying special life event (like getting married or losing a job) in 2014 will owe a penalty and will not be able to secure a qualifying health insurance policy until the next enrollment period (currently scheduled for November 15th, 2014 – January 15th, 2015). See #7 regarding non-qualifying healthcare plans.
- An insurance agent can keep track of changes and new opportunities that will help you have peace of mind about your options and give you confidence in your choice. The options, mandates, penalties and exceptions are still numerous and often confusing for those trying to make the best decisions for medical insurance and healthcare choices in 2014. Working with a licensed, certified and knowledgeable agent will help make the process dramatically easier for you. You may have seen and heard advertisements for insurance alternatives and healthcare products, such as Telemedicine that offer alternatives in the environment of “Obamacare”. Ask your agent to explain these options. Chances are your present insurance policy may already include some of these products at no additional cost. No matter what, you want to be sure that understand any product before you make a purchase.
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Patient Protection & Affordable Care Act (PPACA) information discussed in communications is most accurate as of this date. The Department of Health & Human Services may amend or change federal regulations at any time.