With the passing of the Open Enrollment deadline to sign up for health insurance under the Affordable Care Act (ACA or Obamacare), you might have heard that some who aren’t covered could face a penalty. This is true, but there are extenuating circumstances that could allow certain individuals to avoid a fine. While these issues can be complicated, this article will offer some insights into what you need to know and what questions you might need help with.
What are the deadlines? When is an enrollment period?
As we’ve written about here at HealthMarkets before, there are two main times when you can sign up for health insurance: during Open Enrollment which is scheduled to start again in the fall (exact dates are subject to change and may vary state to state), or during a 60-day Special Enrollment Period due to a “qualifying life event” such as changes in your family size (for example, if you marry, divorce, or have a baby), a job loss, or permanent relocation to an area with different health insurance options.
What is a qualifying life event?
A qualifying life event is a change in your current situation that can make you eligible to enroll in health coverage outside of Open Enrollment during a 60-day Special Enrollment Period following the event. Qualifying events that would trigger a Special Enrollment Period include: loss of existing health coverage because of a job change or job loss; changes in your family due to marriage, divorce or birth/adoption of a child; certain changes in your income or household size; permanently moving to a new location that has a different coverage area as well as others. Please contact HealthMarkets with any questions you might have about qualifying for a Special Enrollment Period.
Am I subject to a penalty?
If you do not have what is called “minimum essential coverage” and do not qualify for any extenuating circumstances, you will likely be penalized for not being covered. The penalty for 2015 is calculated in two separate ways, and you will pay whichever one is higher. This amount will be 2% of your yearly income (with a maximum penalty of the average national premium of an ACA bronze plan) or $325 per individual and $162.50 per child under 18 (with a maximum penalty up to $975). For a breakdown of what you might owe and how you might avoid such penalties by getting covered, contact your local, licensed HealthMarkets insurance agent as soon as possible.
Are there other options?
If you have missed Open Enrollment and do not qualify for a Special Enrollment Period but would still like to sign up for health insurance, you may sign up for temporary healthcare (usually one to twelve months) through a private provider as you would at any other time. Short-term and indemnity health plans as well as a number of supplemental plans can provide temporary coverage for unexpected illnesses and injuries. It’s important to note however that these are not considered “minimum essential coverage” under the ACA and therefore do not satisfy the individual mandate that you have health insurance coverage. If you do not have other health insurance coverage, you may still be subject to a tax penalty. HealthMarkets can answer your questions regarding your options.
Adhering to the Affordable Care Act can be complicated and time consuming. Be sure to contact a local, licensed insurance agent at HealthMarkets Insurance Agency to get answers you need.