(This article was last updated on November 2, 2016)
The next open enrollment period for Obamacare started on November 1 and runs through January 31, 2017. 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’ll give you some tips on signing up for health insurance under Obamacare. And if you’d like to see some estimates on what your costs could be, feel free to use the secure and confidential form below.
There have been several extensions to the enrollment period in the past, but that’s unlikely to be the case this year since this is the fourth enrollment season under the ACA. So if you’re waiting to sign up, don’t. Get a head start on your health insurance for 2017 using our tips below.
We highly encourage consumers to get price estimates by speaking with a licensed agent or health insurance expert. It’s easy to miss out on subsidies or not get the amount that you’re really eligible for by miscalculating your income for the year. Let us help you find affordable health care.
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 2017, 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 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 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 17, 2016)
President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010. The marketplaces opened for business in 2013. Despite numerous challenges to the constitutionality of the ACA in judicial systems all across this country, including the Supreme Court of the United States, and ongoing challenges to and debates regarding the practical and moral efficacy of the act in the halls of Congress every day, the fact of the matter is that American citizens are now required to have health insurance that meets a minimum level of coverage. If you don’t, then you’re 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, your primary concerns should be: whether you have to apply because there are exceptions, how to apply for ACA-compliant insurance and whether your existing coverage meets the new law’s standards.
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 affect most people. There are few exceptions to the individual mandate requiring eligible American citizens to have health insurance, but you should know what the exceptions are in case you fall into one of these categories. Once you’re 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 the individual mandate:
- Recognized Native American or Alaska Native tribes, which 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, which must be formally recognized by the federal government
- A member of a religious sect, formally recognized by the federal government, that has an objection to insurance
- A person who is incarcerated in jail or prison (since the Federal Bureau of Prisons provides inmates with healthcare while serving their term)
- Unlawful immigrants living in the United States(1)
- 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(2)
- People who do not have to file a federal income tax return
- People for whom the lowest-price insurance policy offered through the marketplace exceeds 8% of their household income
- Those who qualify for a hardship exemption
(1) Several types of immigrant statuses qualify people to get health insurance from the marketplace. Examples include lawful residents (those with green cards), people who have asylum, refugees and those with a temporary protected status due to certain circumstances, among others. The full list of qualified immigration statuses can be found on Healthcare.gov.
(2) Young adults can stay on their parents’ plans until age 26.
If you qualify for an exemption based on one of the situations outlined above, you’ve got two options for informing the government:
- (1) Be proactive. The first way to get the exemption is to be proactive and fill out an application to be reviewed and approved. 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.
- (2) Wait. 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 that you’re applying for, you may need to attach documentation 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 an ACA-compliant insurance policy?
Thanks to the free market and technology, Americans have multiple options to apply for ACA- compliant insurance policies. We’ll go over your options, which include:
- State Health Exchange
- Private Insurance Company
Healthcare.gov is the government’s official website for the marketplace, which is a platform created under the Affordable Care Act to assist people in signing up for health insurance. The marketplace offers subsidies to help pay for insurance; these subsidies are only available on the federal site and state exchanges. There are several steps to applying for an insurance policy. We’ll outline each step carefully so that you know ahead of time what information you’ll need to have handy and what to expect when you’re going through the process. Of course, the list of questions and steps outlined below could change if the application is updated, but you’ll at least get an idea of what you’re going to need to start. 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 about 15-20 minutes. Researching and choosing an insurance policy will take longer. Here are the steps:
Step 1: Sign up for an account with Healthcare.gov.
The first step is straightforward. Fill out your name, identify a username, choose a strong password, and select and answer three security questions. Your username will be your email address. Once you submit the initial information for approval, you’ll get an email with a link to complete the login process.
Step 2: Provide your contact information.
After you’ve created an account and received approval, the site will ask you for some general contact information, including your name, date of birth, social security number (optional), address and phone number.
Step 3: Verify your identity.
After filling in your contact information, the site will ask you to call Experian to verify your identity over the phone. Don’t worry. This step is not mandatory, and you can skip this screen and move on with the application without verifying your information.
Step 5: Add to your contact information.
If you didn’t verify your information by calling Experian, or the site needs more information for some other reason, then you’ll be asked about it next. You might be asked about specific details, like your mailing address, and you’ll probably be asked how you want to be notified about your marketplace application and given relevant news alerts.
Step 6: Tell the site if you’re 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, check that option instead.
Step 7: Decide if you need cost assistance.
If earn between 100% and 400% of the federal poverty limit (FPL), then you may qualify for financial assistance, also called a subsidy, from the government. In 2017, the federal poverty limit is $11,880 for individuals and $20,080 for families of three. If you know that you make too much, you can skip this step. For the 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 from the U.S. Department of Health & Human Services or our article about the individual mandate. Note that Alaska and Hawaii residents have higher income thresholds for FPL qualification.
Step 8: Outline who needs coverage.
Whether you’re just signing up for yourself or you need to get coverage for your family members, you’ll need to be prepared to answer questions about who’s signing up at this point. For each person in your family who also needs insurance, you need to a provide full name, date of birth and the relationship to you.
Step 9: Provide your 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, social security number and citizenship status. They also ask whether you are going to file a tax return for 2016, and if so, whether you will do so jointly with a spouse and whether it will include dependents. The next set of questions deals with race and ethnicity.
Step 10: Answer questions about your household.
The next set of questions deals with more information on the people in your family who need insurance, and it also needs to be completed in one sitting. Specifically, the site asks for information regarding whether anyone who was identified as needing insurance has a disability (optional question), needs help with daily living and functioning (optional question) or was ever found to be not eligible for the 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 members of these tribes.
The site then asks whether anyone applying for coverage is pregnant.
Step 11: Review the information listed on the Family and Household section.
Make sure that all of your family and household details are correct. What you enter into the site determines eligibility for financial assistance, so it’s important to provide the appropriate details.
Step 12: Enter your 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 so that you can answer the questions about income.
The first question asks whether you have a job, are self-employed, receive Social Security benefits, pension, unemployment benefits or retirement benefits; income from capital gains, investments, rental properties or royalties; and income from less common sources, such as fishing or farming, alimony or some other type of income. If you receive income of any kind, then you’ll need to report it here. Depending on what kind of income you receive, you may be asked the name of the company that you work for as well as your gross, 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’ll l need to provide the approximate amount. Try to be as accurate as possible when reporting 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 fact-check the numbers.
The application will then calculate the approximate amount of money you make a month after deductions for the year and will ask you to confirm or deny the information. You’ll then need to verify the summary of information provided.
Step 13: Provide additional information about you.
The last category of questions centers on whether you currently have health coverage from some other source. You’ll also be asked about certain qualifying life events that may trigger a special enrollment period. Questions include whether you’ve recently lost or will lose coverage in the next 60 days; whether you’ve gotten married or adopted a child; and whether you’ve recently gained eligible immigration status, moved to another state or have been released from incarceration. If you answered yes to any of these questions, then you’ll need to provide dates. This section is typically used if you enroll outside of the open enrollment period. For people who qualify for special enrollment periods, the penalty tax won’t apply as long as they enroll during that special signup window.
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; whether you agree or don’t agree to allow the marketplace to use data from your tax returns for the next 5 years to determine information; and whether you agree or don’t agree to update your application and/or insurance company of any changes to your circumstances in the future (e.g., you make less money and can get a subsidy, you have insurance through your employer and other circumstances that could alter your current coverage).
Step 15: Get subsidy results, if applicable.
After filling in all of the information requested, you will then be told whether you’re 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: Choose your plan.
The final step is to pick a plan. The plans will be laid out in tiers (bronze, silver, gold and platinum), which equate to price and coverage amount. Bronze plans have the lowest premiums but highest out-of-pocket costs; platinum plans have high premiums but lower out-of-pocket costs. The most common choice among marketplace enrollees is silver-tiered plans. For adults under the age of 30, there’s also a catastrophic coverage option.
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. You can choose which version to take. 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 its own marketplace, then you’ll fill out an application and shop for policies on your state’s health insurance exchange site. Most states do not have their own marketplaces. The Kaiser Family Foundation keeps a running list of where states stand on this issue. If you’re not sure about your state, start with the federal marketplace at Healthcare.gov. The site will redirect you to your state’s site if there is one.
There’s 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 residents.
Residents of certain states do not have to shop for policies on Healthcare.gov at all. If your state is not listed below, that means it’s either relying entirely on the federal program or is involved in a partnership program. A state can transition into a partnership or fully state-based program at any time as long as the state’s legislature passes that law. The fact that your state is running off of a federal-based program today does not guarantee that the state will continue doing so. As of the 2017 open enrollment season, here’s a list of current state marketplaces:
California – http://www.coveredca.com
Colorado – http://www.connectforhealthco.com
Connecticut – https://www.accesshealthct.com
Washington D.C. – https://dchealthlink.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/
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 similar to the application used on Healthcare.gov described above.
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 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. Most important, you’ll need to know the kind of policy that you’re looking for and how much money a month you can spend on that policy.
Question 3: Is my current health insurance policy compliant with the law, and if not, how do I get insurance that does comply?
The third question you should ask yourself is whether your current health insurance, if you have it, complies with the new 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 most do. Plus, your company is required to tell you if your insurance isn’t compliant.
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 legislators wrote the law to help better serve consumers, protect the American people and hold insurers more accountable for their actions.
Obamacare outlines 10 types of services that everyone with health insurance should always be covered for under every circumstance. Before the ACA took effect, it was clear that there were some people who were not getting their money’s worth when it came to health insurance. Some companies simply charged too much for too little. Under the Affordable Care Act, even if you choose the lowest-cost plan with the least amount of coverage, you still receive at least the same 10 essential benefits as someone who buys a more costly 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 ACA-compliant policy look like?
So let’s talk about what your new policy should look like under Obamacare. This information is important because if your policy does not adhere to ACA guidelines, then you won’t be considered covered, and you may be assessed a penalty fee for noncompliance. 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, call your insurance company’s customer service line to verify that your policy is sufficient. Here are the 10 essential benefits required by law:
- Ambulatory care, also known as outpatient care, which includes services that you would get in a doctor’s office or in a non-hospital inpatient setting
- Inpatient hospital care
- Emergency services, including situations that happen in an emergency room at a hospital, urgent care or other type of medical center
- Maternity and newborn care before, during and after birth
- Coverage for mental health care and substance abuse disorders
- Prescription drug coverage
- Rehabilitative and habilitative services, including equipment and therapies
- Laboratory services, such as blood tests
- Preventive and wellness services, including chronic disease management
- Pediatric services, which includes dental and vision benefits for children under 18
My insurance policy does not meet the requirements of the law. 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. If you’ve got work-based coverage, talk to the company’s health insurance administrator. There’s a good chance that the company can work out insurance on its end without your having to fix anything. If you’re 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. Open enrollment runs from November 1, 2016 through January 31, 2017 for the next enrollment season.
If you’ve already missed the deadline to comply, but it’s been less than three months, you can call your insurance company and switch your policy without fear of being taxed for non-compliance. There’s a 3-month leeway period for signing up for health insurance.
If you’re past the deadline and still have a non-complying healthcare policy, and it’s been longer than three months since the deadline passed, you should still sign up for health insurance as soon as you can. You’ll only be charged a penalty for the months that you weren’t covered, so you can lessen the burden by enrolling in a health care plan as soon as possible.
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’re eligible for a subsidy. Check out our article on signing up for health insurance if you want more information on subsidies and your options for enrolling outside of the open signup period.