Open Enrollment Approaching for Health Insurance Marketplace: What You Need to Know

Oct 30, 2015

The federal health insurance Marketplace reopens for its annual enrollment period November 1. Austin Boyland, a certified application counselor with CoxHealth, says there are a number of new things you need to know about the process.

The Marketplace was established under the Affordable Care Act for those who don’t have access to coverage through their employer or can’t afford private insurance.

“The three top questions that we get: One being what is the penalty [if I don’t sign up], two when can I enroll, and three where can I get help?” Boyland says.

Let’s start with the when. Enrollment comes around annually. This year it begins November 1 and ends January 31. Only those with a qualifying life event can enroll outside of this time. It’s important to note that if you want coverage by the first of the year, you’ll need to sign up for insurance by December 15.

Where can you get help? Cover Missouri offers a map directing you to a local certified application counselor (CAC). The service is free.

As for the penalty for not having insurance; it’s going up, according to Boyland. Currently those without health insurance will play a penalty when filing their taxes next year. Boyland says that amounts to a $325 penalty per adult, $162.50 per child, or two percent of a household’s income.  

“Now for 2016 that greatly changes, because you’re looking at about $695 per adult, about $347.50 per child [under 18], or about 2.5 percent of that family’s income.”

Boyland notes that not everyone has to pay the penalty if they don’t qualify, so he’s encouraging those individuals to contact an assistor to see if they may be exempt from the penalty.

In order for someone to qualify for a federal subsidy, or tax credit through the marketplace, they have to make between 100 and 400 percent of the federal poverty level.

“For example a household size of one – in order for someone to qualify [for a subsidy] their income for 2016 has to be projected between $11,770 and no more than $47,080… For a household of three… it’s about $20,090 up to $80,360,” says Boyland.

What about Medicaid? The program provides free or low-cost health coverage to millions of Americans. But there are those that make too much to qualify for Medicaid yet don’t make enough to qualify for a subsidy through the Marketplace, or fall into what is known as the coverage gap. The term is used to describe the gap between state Medicaid eligibility and Marketplace subsidy eligibility in state’s that haven’t expand Medicaid, which includes Missouri.

“So they can get an exemption to the penalty, but that does leave them at risk because they don’t have coverage. So we try to help people connect with Jordan Valley [Community Health Center], Ozarks Community Hospital, kind of the safety net population providers so they can get sliding scales.”

Other important Marketplace Need-to-Knows:

I’m a Medicare recipient. How does open enrollment for the health insurance Marketplace affect me?

“It doesn’t really,” says Boyland. “Medicare open enrollment is separate. If you have Medicare you have health insurance so you don’t have to worry about the penalty. So the health insurance Marketplace really doesn’t play into what Medicare does, it [the Marketplace] really just helps people from 64 or below.”  

What if I’m happy with my existing plan through the Marketplace?

There is an auto enroll feature, according to Boyland. But, “One thing we want people to know is that if you’re getting tax credits and other subsidies to help pay for the premium… you wanna go into your account whether you go online or call the call center and update your income information because that tax credit changes every year.”

He adds that if you’re expecting different medical requirements for yourself or family in the next year, a different plan may be worth considering, in that it could provide better service or come at a more appropriate cost to you based on the medical assistance you’re require.

What’s a qualifying life event?

Examples of ways in which you can sign up for coverage outside of the annual enrollment period would be a change in marital status, employment, if you have children, or move from one coverage area to another. Once the life event occurs, you have 60 days to re-enroll.

Where/How can I sign up?

Healthcare.gov is one way. There are also various in-person options, including a list of where you can find a certified application counselor through Cover Missouri, or you can sign up through the Marketplace’s 24-hour call center at 1-800-318-2596.

Hear the full conversation with Austin Boyland above. You can also find additional information and peruse other frequently asked questions at https://www.healthcare.gov/.