The Affordable Care Act, most commonly known as “Obamacare,” has a number of changes that will take place for the year 2016. Below is a complete guide to everything you will need to know about enrollment in the program:
Dates
Although the changes will take place effective for 2016, there are a number of important dates that start in 2015.
- November 1, 2015 – The beginning of Open Enrollment for 2016. Coverage will begin on January 1, 2016.
- December 15, 2015 – The last day to enroll or change your plan for coverage beginning on January 1, 2016.
- January 1, 2016 – Coverage begins for people who enrolled or changed their plans between Nov 1 and Dec 15, 2015
- December 16, 2015 – Any enrollment or changes will take effect February 1, 2016
- January 15, 2016 – The last day to enroll or change a plan, with coverage beginning on February 1, 2016
- January 16-January 31, 2016 – Enrollments or changes in this period will take effect beginning on March 1, 2016
- January 31, 2016 – The last day of Open Enrollment for coverage in the year 2016.
Anyone who fails to enroll by January 31 will be ineligible for coverage unless they qualify for a Special Enrollment Period.
Note: There are no restrictions as to when you can enroll in Medicaid or CHIP (Children’s Health Insurance Program). Applications are accepted at any time.
Special Enrollment Period
People who have undergone certain major life changes may be eligible to enroll in Obamacare outside of the normal enrollment periods. A Special Enrollment Period gives you 60 days from the event in which to enroll or change your plan.
You may qualify for a Special Enrollment Period:
- If you get married
- When you have a baby
- If you lose a member of your household
- If you gain a member in your household
- You lost your health coverage
Note: you must report these life changes to the Marketplace to qualify for a Special Enrollment Period
Note: if you get hired on at a new job, you have 30 days to enroll in a plan.
Non-Enrollment Penalties
If you do not have any health coverage for 2016, you will be required to pay a fee to the government. This is determined by whichever of the following is the highest:
Either:
- 2.5% of your yearly household income (as long as you exceed the filing threshold, which is about $10,000 per individual adult); OR
- $695 per adult, or $347.50 per child under the age of 18.
The maximum fine assessed will be:
- The national average premium for a Bronze plan; OR
- $2,085 per family
Note: certain hardship exemptions exist for people who don’t have health insurance. These include:
- Being homeless
- Being evicted from your home in the past 6 months
- Receiving a shut-off notice from a utility company
- Being the victim of domestic violence
- The death of a close family member
- Surviving a fire, flood, or disaster that caused substantial damage to your property
- A bankruptcy in the past 6 months
- Unpaid medical expenses from the previous 24 months that resulted in substantial debt
- Increased necessary expenses for providing care for a family member
- Your state failed to expand eligibility for Medicaid, and you were determined ineligible for Medicaid
- Your individual insurance plan was cancelled
Note: hardship exemptions are temporary, and usually only cover the month previous to, the month after, and the duration of the hardship. You must contact the Marketplace in order to qualify for a hardship exemption.
Being Unemployed
No one is automatically exempted from the requirement to obtain health insurance just because they are unemployed. If you are unemployed but do not obtain health insurance, you will be fined.
However, certain people with low (or no) income may qualify for an exemption.
Catastrophic Coverage
If you successfully qualify for a hardship exemption, you will be able to obtain a catastrophic coverage plan regardless of your age or income. This will protect you from certain medical costs. If you qualify for a hardship exemption, you’ll be given an Exemption Certificate Number (ECN) to use when buying the plan from an insurance company.
Premium Prices
Currently, 37 states are participating in the federal Obamacare Marketplace. While prices vary from state to state, the latest figures estimate that premium prices will rise 7.5% across the board for the year 2016.
The changes, however, vary widely from certain states and metropolitan areas. Recently published figures show that residents and Oklahoma and Montana will see their premiums rise as much as 35%, while residents of Indiana will benefit from a 13% drop in prices.
Many of the other 13 states rely on separate ACA insurance marketplaces, with premiums expected to rise a modest 2% on average.
Government press releases emphasize that approximately 90% of people enrolling in an Obamacare plan are eligible for tax credits, which will reduce their total cost.
Mandatory Employer Participation in Obamacare
After being delayed for years, the Employer Shared Responsibility provision of Obamacare will finally take effect in 2016. The regulations require that any company with 50 or more full-time employees must offer their workers and dependent children affordable insurance coverage or face substantial financial penalties.
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