(This article was last updated on January 15, 2016)
The next open enrollment period for Obamacare started on Nov. 1 2015 and runs through Jan. 31 of this year, 2016. Under the Affordable Care Act, you only have a set amount of time to sign up for health insurance in order to avoid paying a penalty fee for non-compliance unless you qualify for an exemption or meet other circumstances. Below, we will give you some tips on signing up for health insurance under Obamacare. Additionally if you would like to view estimates on what your costs could be please use the secure and confidential form below. Your information is not shared with any third parties, you will not be contacted by phone either.
Consumers who might be holding off on enrolling because they believe that there will be an extension for late enrollees like there was last year for the open enrollment period will most likely find that will not be the case this year. Government officials have stated that there will not be an extension, in addition to new restrictions which will limit enrollments after 1/31/2016. The following article by the WSJ has more details.
We highly encourage consumers to get price estimates, and even in the event that pricing might seem too costly, call and speak with a licensed health insurance professional who will be able to determine the maximum subsidy available. It is not uncommon for consumers to miscalculate their actual taxable income, which often creates errors in pricing estimates that would otherwise benefit consumers.
Enrolling on the Exchanges
Before you get started, know that you can’t sign up for health insurance until the open enrollment period starts. For coverage beginning in 2016, that date is Nov. 1. In the meantime, you can prepare for the open enrollment period by gathering the right documents and researching your options. The better prepared you are, the easier your enrollment process will be. Let’s assume that it’s Nov. 1 and you’re ready to sign up for a plan on the marketplace. You have four options for enrolling:
- By phone
- Via mail
- With in-person assistance
When you choose the online route, the process may be much simpler than other methods. The federal and state marketplaces are certainly designed to streamline your enrollment process. Online, you’ll fill out a virtual application and be presented with immediate results based on eligibility. The system will also tell you whether you qualify for cost assistance or federal programs like Medicaid and CHIP. Once you see your options, you can browse through the available plans in your area and select the one that works for you.
Customer service representatives are available 24/7 to answer questions and help you fill out and submit an application for coverage. Similar to the online method, once you fill out an application over the phone with a representative’s help, you’ll be given your available options. The representative will then help you choose and apply for a policy.
You can’t enroll in a marketplace plan via mail, but you can start the application process that way. Paper applications and instructions for filling them out appear at the HealthCare.gov website, and you can mail them directly to the Department of Health and Human Services, the address for which is on the application instructions. Once you mail in the application, you can expect eligibility results within two weeks. After you get your results, create an online account or call the customer service center to enroll.
In many places throughout the country, organizations have been created to help people sign up for health insurance on the marketplaces. You may also find assistance at local brokers’ offices and insurance agencies, or by contacting an agent who specializes in the ACA. On the HealthCare.gov website, you can enter your zip code to find a list of places that offer in-person assistance. These centers will help you fill out an application and enroll in coverage.
The same enrollment process applies to the federal exchange and the state-run marketplaces. To save yourself some time, start by visiting HealthCare.gov and entering in your zip code. The site will tell you how to proceed if you need to enroll using a state-based exchange. Individual exchanges may have slightly different procedures for applying, but the process as a whole is essentially the same.
Private and Job-based Coverage
If you’re wondering about enrolling for health insurance through a private company directly or via your employer, then you’ll need to check in with these places separately. While private insurers typically follow the same enrollment period as the federal government, their process for signing up for coverage may differ. Likewise, your employer sets its own schedule for insurance enrollment. Contact your human resources representative to ask specific enrollment-related questions.
Special Enrollment Periods
As we mentioned earlier, you’ll only have three months to sign up for health insurance, but there is some leeway for people who meet special conditions. For instance, if you lose your job, get married, get released from prison or move, you have 60 days from your qualifying life event to enroll in marketplace coverage. How you enroll depends on whether or not you have marketplace coverage already. Those without marketplace plans will start an application process for the first time, filling out appropriate information and allowing the system to generate available plans.
If you already have a marketplace plan in place, then you’ll need to log on to your account and update your information. There’s a “report a life change” section for special circumstances. Once you submit your new information, you’ll be guided through the application process as usual.
Because life can be messy, the government also allows people to apply for special enrollment periods if their circumstances don’t quite fit the parameters that exist already. If you feel that your circumstances count as particularly complex or difficult to define, then you may be able to sign up for health insurance outside of open enrollment. You can learn more about complex exceptions by reading an overview on the federal marketplace.
If you participate in Medicare, Medicaid or CHIP, then you’ll also have different guidelines for enrolling in insurance each year. Visit Medicare.gov to learn more about the various enrollment periods. You can apply for and enroll in Medicaid and CHIP year round. You can’t use the marketplace to enroll in these programs, but the federal exchange site can tell you how to proceed with an application.
(This article was last updated on October 1, 2014)
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.
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 policy?
Thanks to the free market and technology, Americans have multiple options to apply for Obamacare compliant insurance policies. Each will be explained here.
- State Health Exchange
- Private Insurance Company
Healthcare.gov is the government’s official website for the Marketplace, which is place where Americans can sign up for an insurance policy and receive subsidy assistance to pay for the costs associated with insurance throughout the year or the premium due for each policy. 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.
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, a Healthcare.gov 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 $11,670 and $46,680 for an individual and between $23,850 and $95,400 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: 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 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
Step 12: Income details (if you said previously that you didn’t need any financial assistance you will skip this section)
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: 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 a 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 addressed 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 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. There are two types of subsidies: the first one is a premium subsidy that is applied to your monthly insurance bill, or premium; the second type is a tax credit that is reimbursed to you when you pay your federal income taxes and is used to reimburse a family for their out-of-pocket insurance-related costs throughout the year. Also outlined are the insurance company, the type of policy (HMO/PPO) and the details of coverage.
2. State Exchange
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.
The following list of states has their own state exchanges, which can be found on their own websites. Citizens in these states do not have to shop for policies on Healthcare.gov. If your state is not listed below 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.
California – http://www.coveredca.com
Colorado – http://www.connectforhealthco.com
Connecticut – https://www.accesshealthct.com
Washington D.C. – https://dchealthlink.com/
Hawaii – http://www.hawaiihealthconnector.com/
Idaho – http://www.yourhealthidaho.org/
Kentucky – https://kyenroll.ky.gov/
Maryland – http://www.marylandhealthconnection.gov/
Massachusetts – https://www.mahealthconnector.org/
Minnesota – http://www.mnsure.org/
Nevada – https://www.nevadahealthlink.com/
New Mexico – https://bewellnm.com/
New York – https://nystateofhealth.ny.gov/
Oregon – https://www.coveroregon.com/
Rhode Island – http://www.healthsourceri.com/
Vermont – https://portal.healthconnect.vermont.gov
Washington – https://www.wahealthplanfinder.org
The application required to sign up for health insurance through a state exchange will be very similar to the application used on Healthcare.gov described above.
3. Insurance Providers
The final way to obtain health insurance that complies with the Affordable Care Act’s minimum benefits requirement is to sign up for a policy from a private insurance company. To do this, you can either call or visit the website of a particular insurance company, search for a policy through a website like this one that has access to every qualified insurance policy on the market or you can contact a licensed insurance broker to shop for a policy.
No matter which way you decide to shop, you will still need to have the same basic information accessible and, most importantly, you will need to know what kind of policy you are looking for and how much money a month you can spend to pay for that policy.
Question 3: Is my health insurance policy compliant with the requirements of the law and, if not, how do I get insurance that does comply?
The third question you should ask yourself is how do I know that my current healthcare plan complies with the requirements of the law? If you already have health insurance through your employer or through a private insurance company, chances are that it complies with the law because if it didn’t, you would have been put on notice of that fact already.
If you’re wondering what an Obamacare compliant insurance policy looks like in the first place, it’s easy: it looks either the same or better than your policy terms probably looked like before the Affordable Care Act was passed. This is because the Obama Administration wrote the law with the intent to forcing all insurance companies to up their game and to offer their customers more coverage than before. Obamacare realized that there are ten types of services that everyone with health insurance should always be covered for under every circumstance. When drafting the law and examining the types of services that many insurance companies presently and consistently offered their customers for the steep price that they charged every month, it was clear that there were some people who were not getting their monies worth. Under the Affordable Care Act, even if you chose the lowest cost and lowest coverage plan, you are still receiving some of the same benefits as someone who chose to pay more for a higher plan. Receiving these benefits does not mean that they are free, just that you will not be denied coverage for these services no matter what.
What does an Obamacare compliant policy look like?
So lets get down to the meat and potatoes of what an insurance policy under Obamacare will look like. This information is important because if your policy does not check off the following list of services you will be penalized for not following the law. If you have any doubt, either because you know that you are not covered for these services or because you have not received confirmation from your insurance company that you are in compliance with the law, it may be best to call your insurance company’s customer service line to verify that your policy is sufficient.
- Ambulatory Patient Services. This service describes care you would get outside of a hospital stay for care that could involve general tests, rehabilitation, a minor surgery, diagnostic tests, biopsies and ultrasounds, etc.
- Emergency Services. This service would include anything that happened in the emergency room at a hospital, urgent care or other type of medical center.
Inpatient hospitalization. These services would include things done at the hospital after you were formally admitted as a patient.
- Maternity and newborn care. Any care that you may receive when you are pregnant or for you and your child after he or she is born would fall under this category of services.
- Mental health and substance use disorder. These services would include behavioral health treatments undergone in order to deal with various mental health or disorders related to substance abuse.
- Prescription Drug Coverage. Although there is no provision regarding the actual cost of the generic or name brand drug or the co-pays that insurance companies can assign, your insurance company must include prescription drugs in the coverage plan.
- Rehabilitative and habilitative services. These concepts are confusing but their meanings are simple. If you had function that you lost due to a sickness or injury or you should have a function, which you do not have due to a sickness or injury, then your insurance company will cover therapies like occupational or physical therapies to help you develop or get those function back.
- Laboratory Services. This one is pretty self-explanatory, but if your doctor ordered lab testing such as blood work, it will be covered by your policy.
- Preventative and wellness services and chronic disease management. Services related to this category of coverage would include receiving help to prevent, improve or simply manage the present state of an illness or disease.
- Pediatric services related to oral and vision care. This category is also pretty easy to define. Although oral and vision care for adults is not listed as an minimum benefit that insurance companies must offer their customers, it is required for all children under 18 years old so that they can have the best start to healthy living possible.
My insurance policy does not meet the requirements of the law so how do I get insurance that does comply?
If you determine that the insurance policy that you had in place either through your employer or through a private company before Obamacare started does not meet the requirements of the law, you will need to find new insurance immediately. You may find luck in advising your employer that they are offering insurance that does not comply with the law and hopefully they will simply update their policy so that it complies. If you are self-insured and have a policy that does not comply with the requirements of the law, you will need to get health coverage that does comply immediately.
If you’ve already missed the deadline to comply but it has not been more than three months since that time passed, you can call your insurance company and switch your policy without consequence or fear of being taxed for non-compliance, because being in violation of the law is OK so long as it is for less than three months.
If you are passed the deadline and still have a non-complying healthcare policy and it’s been longer than three months since the deadline passed, you should get good insurance as soon as possible but brace yourself for a penalty for the number of months that you did not comply.
If you want to wait until the next open enrollment period to sign up for insurance then you can do that as well. This may be the best option if you think you are eligible for a subsidy. If this is your planned course of action you can refer to the response to Question No. 2 above for more information about how to sign up for insurance through the federal or state exchange Marketplace.