Healthcare Reform enrollment doesn’t have to be hard or scary. We’ll talk open enrollment, qualifying life events for changing coverage, exemptions, fines, and how to start shopping in your state.
If you didn’t read the previous post on the benefits of Healthcare Reform, just click here. In this post we’ll talk about getting enrolled or not, and when.
The Open Enrollment Period for 2016 if you don’t already have healthcare coverage starts October 1 and ends December 15, though the dates may be subject to change.
Outside of that, you have 60 days to change coverage if you have a “qualifying life event” such as:
- Exceptional circumstances (such as natural disasters, medical emergencies, and planned system outages) near the deadline
- Moving to a new location outside the provider network of their current plan
- Birth or adoption
- Losing existing health coverage
- Misinformation, misrepresentation, or inaction on the part of entities providing formal enrollment assistance
- Enrollment errors due to technical issues
- System errors related to immigration status
- Display errors on marketplace websites
- Delays in application transfers for consumers found ineligible for Medicaid or CHIP
- Error messages
- Unresolved casework
- Misinformation about availability of premium tax credits for victims of domestic abuse who are married but not filing a joint tax return
- Other system errors
There is also no ‘lock out period’ (time when you can’t enroll) for Medicaid or CHIP (children’s healthcare insurance program), so individuals can enroll in these programs at any time.
Thankfully kids who age out of foster care will also qualify for continuing coverage until age 26, also.
Choosing to Pay the Fine
If you have no insurance the fine is currently $695 a year for each individual and 347.50 for each child, or 2.5% of the family’s income, whichever is greater. Ouch.
That amount will be prorated, or divided, according to how many months you don’t have insurance during the year. In other words, you can’t go out and buy insurance in December and wave your paperwork and get out of the fine completely. You’ll owe for the other 11 months. The fine is from the IRS, and that is debt you don’t get out of, no matter what those commercials at 3AM say about negotiating your tax debt.
Remember, if you choose to pay the fine rather than buy insurance you’re not only not in compliance with the law, but you’re also throwing away that money every year. Money that could be going into something you would get some benefit from, including preventive care and checkups.
There are a number of hardship exemptions to the law that you will find on this page of the healthcare.gov site that include domestic abuse, homelessness, certain religious affiliations, being a tribal member, low income, and living in an area affected by a disaster. The link will lead you to a complete list of them as well as linking to the paperwork that must be filed for each one.
Now Start Shopping
Like any other government program there’s all kinds of details that apply to each state and situation, so there’s no way to cover every possible contingency, but I did find a couple of really good places to start.
Offerings change according to what state you live in. WebMD has a really good map to help with that. Just click on your state to get started. You’ll learn what types of insurances are available and what they cover, what help you can get according to your income, and phone numbers and websites for more help to make a decision. Also, every state has it’s own Insurance Commissioner (Here is Washington State’s OIC) and that’s probably the best place to start. They show what coverage is available by county and whether the plans are on or off-exchange.
Remember, you have to be on-exchange to get federally subsidized.
You’re going to have different levels and costs of insurance to choose from, and right up front it all sounds scary expensive, let’s face it. Try not to get overwhelmed, start weighing options without getting emotional and frustrated about it. You’re researching your options, not selling your soul. Don’t automatically figure you should take the cheapest offering with the highest deductible.. Just get a feel for it right now, there’s still time.
Start getting in mind what your actual needs are, how often you go to the doctor and where. Make a list of questions, and don’t be shy about asking them. Take notes, and don’t be in a hurry to commit. Don’t ever let anyone make you feel like you’re asking dumb questions. This is your money and your life, so you need to be able to feel comfortable that you’re making an informed decision.
Next we’ll talk about types of insurance and what all those acronyms mean so you can figure out what’s right for you.