As many of you know, health insurance must be obtained during open enrollment. You won’t be able to purchase ACA compliant coverage for individuals and families outside of the open enrollment without qualifying for a special enrollment period. Open enrollment for 2016 will occur between November 1st, 2015 and January 31st, 2016. Future open enrollments are scheduled to be October 1st to December 15th.
There are many different types of plans that you can have which still meet the minimum essential coverage and avoid the penalty. These plans include:
- Marketplace plans
- Job-based plans
- Medicare Part A or Part C
- Most Medicaid coverage
- The Children’s Health Insurance Program (CHIP)
- If you’re under 26, coverage under a parent’s plan
- University self-funded health coverage offered to students
- Veterans Affairs (VA) health coverage
- Most TRICARE plans
- State High-risk pools
- Expatriate plans
The penalties for not having the minimum essential coverage will be changing in the upcoming year. For our current year (2015) the penalty was 2% of your yearly household income, or $325 per person for the year ($162.50 per child under 18), and $975 maximum per family.
For the upcoming year (2016) the penalty will be 2.5% of your yearly household income, or $695 per person for the year ($347.50 per child under 18), and $2085 maximum per family.
Special Enrollment Period
It is important to note that there are times known as “qualifying events” that will allow a person to obtain the necessary coverage outside of the open enrollment dates during a special enrollment period. These events include:
- Getting married
- Having a baby
- Adopting a child or placing a child for adoption or foster care
- Losing other health coverage
- Moving to a new permanent residence
- Gaining citizenship or lawful presence in the U.S.
- Leaving incarceration
Note: Voluntarily ending COBRA before it expires or quitting a marketplace plan mid-year doesn’t qualify you for a special enrollment period.
You May Be Exempt…
There are several scenarios that may apply to someone allowing him/her to be exempt from the ACA individual mandate. These include:
- You are part of a religion opposed to acceptance of benefits from a health insurance policy
- You are an undocumented immigrant
- You are incarcerated
- You are a member of a Native American tribe
- Your family income is below the threshold for filing a tax return ($10,000 for an individual, $20,000 for a family in 2013)
- You have to pay more than 8% of your income for health insurance after taking into account any employer contributions or tax credits
- You live outside the United States for more than 330 days of a year
Whether you are purchasing health insurance
for the first time or already have a plan in place, or are simply looking for better coverage, we want to help you find an affordable health plan that works for you. MHG Insurance Brokers is an Affordable Care Act certified insurance brokerage, and can offer you expert advice and solutions for you, your family, or your business. If you have any further questions or concerns about the Affordable Care Act and open enrollment, please feel free to contact us here by calling 954-828-1819, or visiting mhginsurance.com
! Don’t forget, Open Enrollment begins on November 1st
and runs through January 31st