Don’t delay: Health insurance enrollment begins Sunday, Nov. 1
Published 5:46 pm Friday, October 30, 2015
Health insurance open enrollment begins Nov. 1, and it must be purchased between then and Dec. 16 to have it become effective by Jan. 1, 2016.
If you wait until Dec. 16 to purchase your insurance, your effective date will be shifted to Feb.1, 2016. The last day of open enrollment is Jan. 31, 2016, which would set you up for a March 1, 2016, effective date.
You must be between birth and 64-and-364 days old to qualify for Affordable Care Act (ACA) plans. These plans must have the minimal essential coverage to be on the ACA approved list. If they are not and don’t satisfy the ACA requirements, then you will have to pay a penalty for not having and approved plan or not having ACA insurance.
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Two types of exchanges will be listed: on-exchange and off-exchange. On-exchange means that you qualify for ACA Plan if your income is up to 400 percent of poverty. If you fall within certain adjusted income requirements, you will qualify for premium assistance from the Federal Government.
If you do not fall within the salary requirements, you will not qualify for premium assistance and you will have to buy your policy on an off-exchange basis, and pay 100 percent of the premium.
All health plans under PPACA — bronze, silver, gold and platinum — have to provide certain essential benefits in order to market themselves on a state exchange as a qualified health plan, including emergency care, mental health services and treatment for longterm diseases.
It’s also important to note that some exchanges will offer voluntary products — dental, life and vision insurance and others, for example — on the exchanges. The other coverages do not get a supplemental subsidy from the government, only the ACA health insurance plans.
The bronze plan is the lowest premium, has 60 percent approximate coverage and is highly deductible. The silver plan is the second lowest premium, has 70 percent approximate coverage and has a separate medical and prescription deductible. The gold plan provides 80 percent approximate coverage and also has a spearate medical and prescription deductible.
Gold plans likely will be most popular among individuals or families with chronic health problems because they cover more of the costs. Gold plans have a lower deductible, and more benefits before hitting the deductible.
If you are a single person, will file a 2016 Tax Return, and make between $11,770 and $47,080 for 2016, you will qualify for a subsidy. If you make less than $11,770 or more than $47,080, you will not qualify. If you make less, you may qualify for Medicaid.
If you qualify, you have to use the household Adjusted Gross Income, for how you file your taxes. So if you and your wife make from $21,187 to $63,720, you will qualify, but if you under estimate your 2016 income, you may have to pay some back at Tax Time. Works a little like Estimated Tax Payments.
Information for this article was provided by George E Daniel Jr, CIC, CPIA at Danielhealth in Bainbridge.