Health Insurance and You
Learn all about your health insurance options. The Affordable Care Act, more commonly referred to as Healthcare Reform, is designed to remove obstacles to quality, low-cost health insurance for millions of Americans. It guarantees that no one will have to fear the loss of their health insurance if they change jobs or get laid off. There will also be greater protection for people with pre-existing conditions.
You will find information and answers to some frequently asked questions here:
What health benefits are covered under Affordable Care Act plans?
Qualified Affordable Care health plans cover the following essential health benefits:
* Emergency services
* Prescription drugs
* Laboratory services
* Ambulatory patient services (outpatient care you get without being admitted the hospital)
* Maternity and newborn care
* Mental health and substance use disorder services, including behavioral health treatment.
* Pediatric services, including dental and vision
* Preventive and wellness services and chronic disease management
* Rehabilitative and habilitative services and devices (services to help people gain or recover mental and physical skills.)
Specifics of what’s covered within these categories may vary somewhat from plan to plan.
What is the penalty for not having health insurance?
In 2016, if you don’t have coverage or an exemption in 2016, you’ll pay the higher of these two amounts: 2.5% of your yearly household income, or $695 per person ($347.50 per child under 18.) You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage. If you don’t pay the fees, the IRS will hold back the amount of the fee from any future tax refunds.
How long do I have to sign up?
This year’s Open Enrollment period begins November 1, 2016 and ends January 31, 2017. Unless you have a qualifying life event or an exemption you will not have an opportunity to enroll again until the next Open Enrollment period in the fall of 2017.
After I enroll in a plan, how long will it be before it goes into effect?
Important dates for 2017 enrollment:
- November 1, 2016: Open Enrollment starts — first day you can enroll, re-enroll, or change a 2017 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2017.
- December 15, 2016: Last day to enroll in or change plans for coverage to start January 1, 2017.
- January 1, 2017: 2017 coverage starts for those who enroll or change plans by December 15.
- January 31, 2017: Last day to enroll in or change a 2017 health plan. After this date, you can enroll or change plans only if you qualify for a Special Enrollment Period.
Your first premium must be paid by the date specified for coverage to begin.
I had coverage last year. I want to continue with the same plan for the coming year. Do I have to do anything during Open Enrollment?
Your coverage may automatically renew if the same policy is being offered by your insurance provider. There are a few things for you to do before you allow this to happen. Your insurance provider should have sent you a letter outlining any changes in your plan and/or premiums for next year. It is your responsibility to review this information to make sure your plan still fits your needs and budget.
If you are receiving a tax credit or subsidy, you will need to update your income and family information to determine if this amount will be changing.
Can I change my private health plan coverage outside of Open Enrollment?
There is a special enrollment opportunity to get private non-group coverage if you have a specific qualifying life event. Qualifying life events include:
* Having a baby, adopting a child, or placing a child in foster care.
* Losing other health coverage due to divorce or legal separation
* Loss of dependent status ( ‘aging’ off a parents’ plan when you turn 26)
* Loss of eligibility for other coverage, including COBRA benefits ending or losing student health benefit eligibility because you’re graduating.
* Moving to another state or outside of your health plan service area
* Change in immigration status
* Losing eligibility for Medicaid or the Children’s Health Insurance Program
Important: If you leave your job for any reason and lose your job-based health coverage when you do, you qualify for a Special Enrollment Period. But if you voluntarily drop an individual insurance plan, or drop a job-based plan without leaving your job, you don’t qualify for an SEP. When you experience a qualifying event, your special enrollment opportunity will last 60 days from the date of that triggering event.
I signed up for a Bronze plan with a high deductible during Open Enrollment. Now, six months later, I need surgery and would rather be in a different plan with a lower deductible. Can I change plans?
No. In general, once you choose a plan, you are locked into its coverage for the next year or until the next Open Enrollment period. You are not eligible to make changes based on your health status.
I have COBRA. Can I drop it during Open Enrollment and enroll in an Affordable Care Plan instead?
You can sign up for an Affordable Care plan during Open Enrollment even if you have COBRA. Once your new coverage begins, you will have to drop your COBRA coverage. After Open Enrollment ends, if you drop your COBRA coverage or stop paying your premiums, you will not be eligible for a special enrollment opportunity and will have to wait until the next Open Enrollment.
I retired early. My wife and I have been without health care coverage ever since. Do I qualify for Affordable Care Act coverage?
Yes, you are eligible. A major challenge for many early retirees used to be finding affordable health insurance to bridge the gap until they were age 65 and eligible for Medicare. Many were denied coverage or charged higher premiums because of a preexisting condition. The Affordable Care Act changed all this. Insurance providers may no longer reject you or charge higher premium rates because of your health.
I am turning 19 and covered under my parent’s health plan as a dependent. How long can I be covered as a dependent?
Health plans that offer dependent coverage must cover dependents up to their 26th birthday.
If a child is under age 26 and eligible for coverage through their parent’s plan, can they get a lower cost plan based on income if they apply themselves?
It depends on whether the child is a dependent in the parent’s tax household. If the under-26 child is claimed as a dependent in the parent’s tax household – and if they have access to a parent’s job-based coverage – they are not eligible for lower costs on a Marketplace plan. This is because they have access to job-based coverage. If the child files taxes themselves, they may be eligible for lower costs on a Marketplace plan based on their income. This is true even if they have access to a parent’s job-based coverage.
But if the child is enrolled in a parent’s job-based coverage, they are not eligible for lower costs on a Marketplace plan.
My son is turning 26. What are his health insurance options?
Coverage for adult children ends on a child’s 26th birthday when they are required to secure their own health insurance.
Regardless of whether their birthday occurs during Open Enrollment or not, they will qualify for a Special Enrollment Period that allows them to sign up for a health plan outside of the Open Enrollment. The Special Enrollment Period will end 60 days after their birthday.
If they enroll before their 26th birthday, coverage can start as soon the first day of the month they lose coverage. If they enroll during the 60 days after their birthday, coverage will start the first day of the month after they pick a plan. If they don’t enroll in health coverage within 60 days of their birthday, they will not have to wait to get coverage until the next Open Enrollment period and may have to pay the fee for being uninsured.
You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage. If you don’t pay the fees, the IRS will hold back the amount of the fee from any future tax refunds,
While we have made every effort to provide accurate information in these FAQs, people should contact us at Mutsko Insurance Services, LLC for guidance on their specific questions and circumstances.