Applying For Obamacare During Open Enrollment
President Obama passed the Patient Protection And Affordable Care Act on March 23, 2010. Although there were numerous challenges to the constitutionality of the Act in judicial systems all across this country, including the Supreme Court of the United States, and there continues to be challenges to and debates regarding the practical and moral efficacy of the Act in the halls of Congress everyday, the fact of the matter is that American citizens are now required to have health insurance that meets a minimum level of coverage or else they are breaking the law.
Unless and until the Affordable Care Act, which is more commonly referred to as Obamacare, is repealed or amended so substantially that it no longer requires insurance coverage for all Americans, the only thing that people should be worried about is 1) whether I have to apply because, yes, there are people who do not have to follow this law, 2) how do I apply for Obamacare compliant insurance and, 3) if I already have insurance, is it good enough to comply with the law.
Before we get into the questions, we do want to disclose that we strongly feel that you would best be served to enroll with a licensed agent in an ACA (Obamacare) compliant healthcare plan. The reason for this is simple. There are a lot of available options, and there's always a lot of fine print, having a licensed agent helping you through this process is almost always a faster and less complicated way to obtain healthcare. Pricing is regulated, so there is very little financial impact, if any at all, in allowing a licensed insurance agent to serve you.
Additionally one other thing to note is that licensed agents are able to answer any question you might have regarding if a plan is a good fit for you based on your unique circumstances. This is entirely the opposite of what the ACA navigators are able to do. Why? Because the ACA Navigators, also known as the people answering the phone at Healthcare.gov, they are not licensed insurance agents, therefore they can not provide you with their opinion on whether or not a plan is a good choice for you.
Often consumers will have their insurance agent call into Healthcare.gov's hotline to help them walk through the enrollment process. Any agent that you are connected through within our HealthNetwork can not only listen to your specific needs and find the right plan, but they can even help you enroll online directly through Healthcare.gov. For more information simply call our toll free number or use one of the many links within this site. (Like the one below)
Now wait, before we get started officially, let's find out if you even have to sign up for health insurance in the first place.
Question 1: Do I even have to apply for insurance under Obamacare?
Whenever government passes a new law, the first question on everyone’s mind is whether the law applies to them. In many cases, as is the case with the Affordable Care Act, the law will effect more people than not. The list of people that the Affordable Care Act does not apply to is small but it is important to know who those people are in the event that you ever find yourself in that category or in the event you are part of one of those categories now. The moment that you are no longer part of a category of people exempt from getting health insurance under Obamacare, you must comply with the law and obtain a policy that meets the minimum standard of benefits.
The following groups of people may be exempt from complying with the requirements of the Affordable Care Act:
- A member of an Indian or Alaska Native tribe – They must be recognized by the Department of the Interior and typically receive healthcare benefits from other governmental programs.
- A member of a healthcare sharing ministry – The ministry must be formally recognized by the federal government.
- A member of a religious sect that have an objection to insurance – The religious sect must be formally recognized by the federal government.
- A person who is incarcerated in jail or prison – The Federal Bureau of Prisons provides inmates with healthcare while serving their term.
- Unlawful immigrants living in the United States – There are several types of immigrant statuses that are qualified to obtain healthcare from the Marketplace, such as if a person is a lawful resident (has a Green Card), has asylum, is a refugee, has a temporary protected status due to certain circumstances, etc. The full list of qualified immigration statuses can be found on Healthcare.gov.
- People who have been without healthcare for three months or less.
- People who are under the age of 26, who do not have healthcare through an employer – This group of people can remain on their parent’s health insurance program until their 26th birthday.
- People who do not have to file a federal income tax return – You will need to refer to the IRS’ guidelines to determine if you have to file a tax return.
- The lowest-price insurance policy offered through the Marketplace is more than 8% of your household income – This would mean that obtaining health insurance is simply unaffordable even with a subsidy.
- You qualify for a hardship exemption – A hardship exemption is more specifically explained in the article within this site regarding the Individual Mandate.
If a person believes that they could qualify for one of the exemptions listed they can do one of two things to inform the government that they did not have to have healthcare for all or a portion of the calendar year.
The first way to get the exemption is to be proactive and fill out an application to be reviewed and approved for an exemption. The application should be submitted before the deadline to enroll passes so that there is a record of the fact that you do not have to comply with the law. If you find out that the government did not approve your exemption status and the enrollment period has not closed yet, you can still get insurance within time and will not be taxed for breaking the law. This is the most proactive way to deal with your exemption status.
The second way to advise the government of an exemption status is to claim that exemption on your annual income tax return. Although this method is probably the most convenient, it could cause problems if the government determines that you were not actually eligible for an exemption status. If this occurs, you will be taxed for not having health coverage when you should have.
Depending on the type of exemption you are applying for, you may need to attach other types of documents to the application to substantiate your claims. All of the exemption forms and the supporting documents required, if any, can be found on Healthcare.gov.
If your exemption request is approved either through the formal application or your statement on your tax return, you will receive an Exemption Certificate Number, which you must cite on future tax returns for as long as the circumstances surrounding your exemption exist.
Question 2: How exactly do I apply for Obamacare compliant insurance?
Thanks to the free market and technology, Americans have multiple options to apply for Obamacare compliant insurance policies.
Healthcare.gov is the government’s official website for the Federal Marketplace, which is place where Americans can sign up for an insurance policy and receive subsidy assistance to pay for the costs or be forwarded to the appropriate website to enroll in your state's Medicaid program . There are several steps to applying for an insurance policy and each will be outlined carefully here so you know ahead of time what information you need available and what to expect when you are going through the process. Of course, the list of questions and steps outlined below could change if the application is updated but you will at least get an idea of what is required in order to apply. If you have all of the necessary information at your disposal and are able to fill out the entire application in one sitting, the entire process should take approximately 15-20 minutes. Researching and choosing an insurance policy will take longer. If you are entirely new to healthcare, you should seriously consider speaking with a licensed insurance agent about the different plans and options that are available within Healthcare.gov.
Step 1: Sign up for an account with Healthcare.gov
This hurdle is really very standard. You are required to fill in your name, identify a user name, which will be your e-mail address, pick a password that they identify as “strong”, and select and then answer three security questions. After you submit your account login information for approval, you will need to wait for an e-mail to your account, which contains a link to follow to complete the login process.
Step 2: Contact information
After you have properly created an account, the site will ask you for some general contact information about yourself such as your name, date of birth, social security number which is optional, your address and phone number.
Step 3: Verify your identity
After filling in your contact information, the will ask for you to call Experian to verify your identity over the phone. Thankfully this step is not mandatory and you can skip this screen and move on with the application without first verifying your information.
Step 5: More contact information
Either because they needed more information or because you chose not to verify your identity by calling Experian first, the application will ask for more contact information, such as your mailing address and information regarding how you would like to receive notices related to your application for insurance through the Marketplace and other on-topic news alerts.
Step 6: Are you getting help with the application
If a navigator, certified application counselor, non-navigator assistance personnel or an agent or broker is helping you fill out the application, Healthcare.gov wants to know about it. If no one is helping you fill out the information, you need to click on that option instead.
Step 7: Do you need help paying for your insurance policy
If you think that you make between 100% and 400% of the federal poverty line, which equates to between $11,770 and $47,080 for an individual and between $23,550 and $94,200 for a family of four people, you may qualify for financial assistance, or a subsidy as it is also known, from the government. If you know that you make too much you can skip this step. For purposes of this article, we will not skip this step. You can get more information on the income requirements per family size to qualify for a subsidy on the article within this site about the Individual Mandate.
Step 8: Disclose who needs coverage in your family
If you are only signing up for insurance for yourself or if you also need coverage for your spouse and/or children, you will need to be prepared to answer questions about them at this point. For each person in your family that also needs insurance, you need to provide the application with their full name, date of birth and their relationship to you.
Step 9: Family and household personal information
The application warns that you have to fill out the information for this section and complete this step in one sitting otherwise you will lose all of the information when you log out of your account and may have to resubmit everything when you sign back in at another time.
Regarding this step, the site will ask questions regarding each person you are seeking insurance for separately. In particular, it asks for you to clarify the sex of each person, the social security number and whether he or she is a citizen of the U.S. They also ask whether you are going to file a tax return for 2014, and if so, whether you will do so jointly with a spouse and whether it will include dependents (children). The next set of questions deals with the person’s race and ethnicity.
Step 10: More questions about the household
Although still within the category of questions that needs to be answered in one sitting, the next set of questions deal with the details of the people in the family that are in need of insurance. In particular, the site asks for information regarding whether anyone who was identified as needing insurance has a disability (this is an optional question), needs help with daily living and functioning (this is also an optional question) or was ever found to be not eligible for CHIP (Children’s Health Insurance Program) or Medicaid since October 1, 2013. This last question is not an optional question and must be answered before moving on to the next set of questions.
After this set of questions, the site will then ask if you are an American Indian or an Alaska Native. There are other governmental health insurance programs available to people that fit these categories as indicated in response to Question No. 1 above.
The site then asks whether anyone applying for coverage is pregnant.
Step 11: Review the information listed on the Family and Household section carefully
Make sure that all of the personal information and data is 100% correct. Anyone who has data that isn't correct will get flagged and it could lead to your application not being fully completed. Sometimes you will not be made aware of this until weeks and or possibly months later. So it can have a troubling effect for anyone who is seeking serious medical treatment in the short term. Little mistakes that are easy to overlook can completely prevent an application from being submitted. This is one of the primary reasons that we recommend consumers enroll through the assistance of a licensed and insured health insurance agent. Agents have done this literally thousands of times, so they know exactly what to look for.
Step 12: Provide income details if you are seeking a subsidy
The site recommends that you have your last tax return or W-2 forms and recent pay stubs available to obtain financial data from.
The first question asks whether you have a job, are self-employed, receive social security benefits, pension, unemployment, retirement, capital gains, investment, rental or royalty, fishing or farming, alimony or some other time of income. If you receive income from one of these you will need to specifically indicate which one and how much income you receive. Depending on what kind of income you receive, you may be asked the name of the company your work for or your gross or net monthly or annual income from that source.
Next the application asks whether you pay alimony, student loan interest or some other type of payment that is typically deducted from your income tax return. If you pay one of these payments in a year you will need to quote the approximate amount. You should try to be as accurate as possible when quoting this or any other amount on the application because the exact amount will be identified on your tax return and it will be easy for the government to determine whether you were truthful or not.
The application will then calculate the approximate amount of money you make a month after deductions for the year in question and will ask you to confirm or deny the information. The application will then ask you to verify the summary of information provided.
Step 13: Provide additional information about you
The last category of questions that the application seeks is additional information regarding whether you presently have health coverage from some other source.
The application asks whether the person recently lost insurance coverage for one reason or another or if you are going to lose your insurance in the next 60 days, whether you recently got married, were adopted, gained eligible immigration status, recently moved to another state or was released from incarceration. If the answer to any of these questions was yes, it will ask for the date that this event occurred. These questions will likely only be present if the application is being filled out after the enrollment period deadline passed. People who answer in the affirmative to these questions may qualify for the Obamacare Special Enrollment Period whereby they can sign up for insurance after the regular enrollment period deadline without being taxed.
Step 14: Review everything and answer a few final questions
The application will summarize everything that you submitted and will ask you to confirm the information. It will then ask whether you agree or disagree that no one applying for healthcare is incarcerated (being incarcerated is an exception to the requirement to get insurance as address in response to Question No. 1 above); whether you agree or disagree to allow the Marketplace to use data from your tax returns for the next 5 years to determine information and whether you agree or disagree to update your application and/or insurance company of any changes to your circumstances in the future (i.e. you make less money and can get a subsidy, you have insurance through your employer, etc.).
Step 15: Get the results as to whether you qualify for a subsidy
After filling in all of the information requested you will then be told whether you are eligible for a subsidy to help you pay your monthly premiums. If you did not request financial assistance you will go straight to the next step.
Step 16: What are you options for health insurance?
The final step is to pick a plan. The plans will be laid out in terms of level, which equate to price and quality. The levels in order of least expensive and least coverage to most are: catastrophic, bronze, silver, gold, platinum.
If you qualify for a subsidy, that amount will be clearly identified in relation to the total price of the monthly premium. Also outlined are the insurance company, the type of policy (HMO/PPO) and the details of coverage.
If you live in a state that has passed legislation so that it will manage and implement its own state-funded insurance marketplace then you would fill out an application and shop for policies on your state’s website. If you are unsure whether your state has opted to run its own state exchange you can either refer to the list in this article or you can go to Healthcare.gov and indicate the state that you reside in and it will inform you whether you should stay on Healthcare.gov or whether you should go to a different website to shop for insurance.
There is also a group of states that are partnering with the federal government to implement the requirements of the Affordable Care Act. These states rely on Healthcare.gov to provide insurance policies but are responsible for managing certain functions of the program while still being empowered to make certain decisions for their citizens.
States Using Their Own Healthcare Exchange That Are Not Partnered With Healthcare.gov
- District of Columbia
- New Mexico
- New York
- Rhode Island
For links to your states exchange, please go to the Obamacare In My State information page. Within that page you will find links to all state pages as well as detailed information about each state and their current status with the federal and or their unique state exchange. The reason we mention this, is that certain state exchanges have had significant enrollment problems, Maryland being one example. Maryland has had serious problems and has at one point considered scrapping their own state marketplace and joining the federal marketplace on Healthcare.gov. At this time however they still plan to continue on with their own state exchange.
Citizens in these states do not have to shop for policies on Healthcare.gov. If your state is not listed above it is either relying entirely on the federal program or is involved in a partnership program. A state can still transition into a partnership or fully state-based program at any time so long as the state’s legislature passes that law so the fact that your state is running off of a federal-based program today does not mean that they could not change in the future.
You might also be interested in learning about the actual Obamacare enrollment numbers since both state and federal marketplaces ahem opened since the official launch of Obamacare on October 1st, 2013.