If you’re shopping for health insurance on the federal marketplace or your state’s health insurance exchange site, then you’ve probably noticed that you have to sign up during a certain time period. The Affordable Care Act mandates that every eligible American citizen enroll in a qualified health plan by a certain date each year. How you sign up for coverage depends on your needs. While “Obamacare” in and of itself is not insurance, when people reference “signing up for Obamacare,” they usually mean insurance that you get from the marketplace. Our goal is to help you understand how to sign up for health care coverage using this newly created system under the ACA.
Documents That You’ll Need
When you enroll in any type of insurance, you’ll have to provide information related to your household, age, income and other characteristics so that insurers know how to price your plan options. New regulations prevent discrimination based on pre-existing conditions and gender, but you’ll still have to give potential insurers some details about your life. The same holds true on the marketplace. Here are a few things that you may need to have in front of you when you first sign up:
- Basics like name, date of birth and home address
- Information about your household, including your spouse and dependents
- Information on everyone who’s applying for coverage, including social security numbers for everyone on the application
- Income and employer information for every applicant
- An estimate of your annual income for the next tax year
- Information about how you file your taxes
- Policy numbers for any coverage that you already have
These are the basics that you’ll need, but there may be additional documentation required. For instance, if you’re a legal immigrant, then you’ll need to provide your immigration documents. If you’re using a broker or agent to help you enroll, then you’ll need to provide that person’s information as well.
How to Sign Up on the Marketplace
Once you’ve gathered your documents and information together, you can check out the HealthCare.gov website to get started. Even if your state has its own marketplace, starting with the federal exchange site will get you to the right place to enroll. Keep in mind that there is a designated time frame for enrolling on the marketplace, which we’ll talk about in the next section.
You have four options for using the marketplace to sign up for health insurance. You can complete the process entirely online, call the customer service line, mail in an application to get started, or visit a local broker or agent for assistance. Mailed-in applications only get the ball rolling. You can’t actually enroll in health insurance by mail, but once you send in the initial application, you can work with a person over the phone or locally to complete the process. You’ll receive a response via mail within two weeks about your eligibility.
For phone and online applications, you can complete the whole process, including taking advantage of subsidies. Using the website makes enrollment quicker, but if you’re more comfortable speaking with a customer service representative, then choose the phone route. Either way, your eligibility results are instant. That means that if you qualify for cost assistance, then you’ll know right away if you use the website or the phone service. When you sign up online or by phone, you’ll be guided step by step through the process. Phone service is available 24/7, but there are higher call volume times that may delay your application.
Signing up for health insurance can be tough even if you’re computer savvy, which is why you also have the option to speak with a person locally if you’d prefer. The HealthCare.gov website lists local agencies that offer in-person assistance for signing up on the marketplace. Just enter your zip code, and a list will populate based on where you live. You can make an appointment and have an experienced ACA rep or insurance agent guide you from start to finish.
Deadlines and Penalty Fees
The new health care law limits when you can sign up for health insurance to one time each year beginning in the fall. If you want to enroll in a private plan on or off the marketplace, then you’ll have to adhere to the open enrollment schedule. For coverage starting in 2017, you have from November 1, 2016 through January 31, 2017 to sign up. If you don’t enroll during this time frame without a valid reason, then you’ll owe the penalty fee, also called the shared responsibility payment, when you file your taxes the following spring.
The penalty fee goes up in 2017. While the rate started out as the greater of 1 percent of your taxable income or $95 in 2014, this year the fee increases to the greater of $695 or 2.5 percent of your taxable income. Rates for 2017 have not been posted. Foregoing health insurance will become increasingly expensive as the rate is adjusted for inflation each year.
Note that the penalty fee applies for every month that you didn’t have coverage, minus three months. If you enroll in a plan outside of the open enrollment period due to special circumstances, then you’ll only be assessed the penalty fee for the months that you weren’t covered.
Most people have to obtain health insurance by law, but there are some exceptions to the rule. For instance, people who are incarcerated or non-legal residents won’t have to buy insurance. You also don’t have to sign up if you’re a member of a federally recognized Native American tribe or you participate in an approved health care sharing ministry.
There are also exceptions to the deadline requirement for certain situations. The government recognizes that devastating life events or significant changes to your circumstances can interfere with your ability to sign up for coverage. If you experience a qualifying life event, then you may be able to sign up for health insurance outside of open enrollment. You only get 60 days from the date of the event to enroll; after that, you’ll be subject to the same penalties as everyone else.
(This article was updated on November 10th, 2014)
The Affordable Care Act made health insurance more widely available to millions of Americans, in fact more than eight million Americans obtained affordable healthcare as a result of the ACA. Some people however missed out on open enrollment for 2014 due to widespread confusion about the website, deadlines or healthcare coverage itself. If you’re looking for information on how to sign up for Obamacare, then you’ve come to the right place. We want to help you sort through the misinformation to determine how you can protect yourself and your loved ones with proper health insurance coverage. Even if you’ve missed the deadline for 2014 enrollment season, you may still have options for obtaining coverage with a plan that is compliant with Obamacare. Read on to learn more about the enrollment deadlines and other relevant signup information concerning the Affordable Care Act.
Initial Enrollment Deadline For Obamacare
The 2014 initial deadline to obtain healthcare coverage was March 31, 2014. For many people, this deadline came and went too quickly thanks to mass confusion about the subject. In fact, the very first deadline was actually in January, but the government offered a three-month extension to help people get on board. If you didn’t sign up for Obamacare, didn’t enroll in private healthcare coverage or didn’t sign up for a plan offered through your employer, then you may be charged a per-month penalty fee assessed by the Internal Revenue Service or IRS, excluding the first three months.
The 2015 open enrollment period begins on November 15, 2014 and ends on February 15, 2015.
Current Deadlines for Obamacare Open Enrollment
As mentioned above, March 31st was the final deadline for open enrollment in 2014. The Affordable Care Act was initially signed into law in 2010, but a variety of legal and political concerns kept pushing the implementation date back until October of 2013. At that time, very few people understood the complexities of the law and what it meant to the American healthcare system. Thanks to misunderstanding and confusion, many people neglected to enroll in healthcare by the initial deadlines. January 31, 2014 was set to be the first deadline, but the government offered an extension to overcome initial trepidation about the law. The extension effectively allowed for a six-month enrollment period between the October implementation date and the final extended deadline.
For 2015, people won’t have a generous three-month extension, and the enrollment period will be half as long as the initial signup period. The next open enrollment period begins on November 15, 2014 and runs until February 15, 2015. If you don’t have coverage for 2014 and plan to enroll in Marketplace insurance, then you will need to sign up for a plan within this three-month period in order to avoid future penalty fees.
If you enrolled in a plan in 2014, rest assured that your plan will automatically renew for 2015 unless you want to change plans.
As with most health insurance plans purchased through your employer, you can only apply for a new Marketplace plan once every year during the open enrollment period. Because of this limitation, you should look through your options early to determine if you need to upgrade or downgrade your coverage. Researching your options ahead of time will help streamline your next enrollment and ensure that you get the coverage you need.
Understanding the Health Insurance Exchange And Your Options To Sign Up For Obamacare
First, let’s take a look at the government health insurance exchange website that most people refer to as simply “the Marketplace.” The Marketplace acts as a virtual shopping mall where you can browse through several health insurance plans that meet your needs and the needs of your family. For example, you may consider a Bronze plan that comes with a low monthly premium but high deductibles. Regardless of the plan you choose, your healthcare coverage will include ten essential benefits. More information on these essential benefits can be found on subsequent pages, but they generally cover basic wellness visits and preventative care.
The Marketplace also acts as a portal for your state’s health insurance exchange. For example, people living in Tennessee would visit www.healthcare.gov to begin their search for healthcare coverage. From this website, Tennessee residents can learn about enrollment periods, exemptions, health insurance options and other relevant information needed to enroll in a plan. They can also apply for coverage and check for their eligibility for Medicare, Medicaid and the Children’s Health Insurance Program or CHIP.
In 2014, citizens had until March 31, 2014 to enroll in a government plan, sign up for coverage through their employers or obtain private insurance. By April 1st of this year, more than eight million people had enrolled in Obamacare. However, millions still live without insurance. In the next few sections, we’ll help you figure out what to do if you’re part of the uninsured population. You do have options, so don’t despair when it comes to finding quality coverage.
Keep in mind that certain people and groups may be eligible for exemptions from the non-compliance or shared responsibility fee. Native Americans, those who are incarcerated, those who fall below the federal poverty line, religious practitioners and others may not have to obtain insurance or pay the penalty fine. A full list of exempted groups is available on the government’s Marketplace as well as other pages on our site.
Applying for Coverage on the Health Insurance Marketplace
Now that you understand more about the deadlines, exemptions and fees, you may be wondering how to get in on the action and avoid penalty fees for next year. In this section, we’ll go over how to sign up for a plan on the Marketplace and some steps for making the process as straightforward as possible. Just remember that unless you qualify for a special enrollment period, you need to sign up for a plan during open enrollment. For 2015, the period lasts from November 15, 2014 to February 15, 2014. This is the only time for 2015 when you can sign up for a Marketplace plan. Sooner is always better because signing up early ensures a smooth transaction.
Why does it take so long to sign up for a plan? For starters, the Marketplace offers a lot of information that may be difficult to navigate at first. You’ll also need several documents and information for verification purposes. Like filing for a tax return, signing up for a Marketplace plan can take time and effort but is worth the investment. Here are a few tips to get you started:
- Go to www.healthcare.gov and sign up for an account. You’ll offer basic information like your name, address and phone number before creating login information such as a username, password and security question.
- Begin filling out an application. If you file an individual tax return or file one return for your whole family, then you can fill out the application without assistance from a representative. The application includes questions related to your filing status, income, healthcare needs and other relevant information.
- The Marketplace will present you with options based on your application. Options could include the plans offered by the government, private insurance plans or government assistance programs. You’ll also find out if you qualify for subsidies, lower monthly premiums and other features that could reduce your overall burden.
- Once you find a plan that works for you, enroll through the website. Unless you qualify for government assistance like Medicaid or CHIP, you can enroll without speaking with a representative. Otherwise, someone will contact you to help you enroll in one of the assistance programs.
This enrollment process applies to the state exchange sites hosted by the Marketplace. Some states may offer different enrollment sites, so check your state’s site to make sure you’re using the right tools. The step-by-step guide above also refers to single tax-return families or individuals. If you file more than one tax return in your family, then you’ll need to contact the Marketplace’s call center before you fill out an application. Special rules apply in your case, and you’ll need to verify that you’re filling out the right application to ensure effective enrollment.
If you don’t feel comfortable using the Marketplace website, then you have three other options for signing up for Obamacare. You can locate a physical office using the healthcare.gov website, call the toll-free number and speak with a representative or mail in a physical application to the address listed online. These alternatives may take longer, but the end result is the same.
A better alternative for people who need or want a little additional help enrolling in a plan on the Marketplace is to enlist the help of a license health insurance agent or broker. These people can not only provide you advice about which plans will work best for your needs, but their help is free to the consumer and can be given over the phone, over the Internet or in person.
What kind of information should you have before you sign up on the Marketplace? As with any detailed government operation, you need to make sure you have all of the right documents in front of you to ensure a smoother process. Technical glitches and administrative errors notwithstanding, you can avoid a variety of problems by gathering all of the necessary information before visiting the website, speaking with a representative or mailing in your application. Here are some basic documents you might need:
- Your social security number
- Document numbers for legal immigrants where applicable
- Your family’s tax returns for the previous year
- Statements that project your income for the year
- Income information including employer name and address for every eligible person in your household
- Policy numbers for existing healthcare plans that cover eligible parties within your household
- Medical records relevant to your weight, age and smoking status
The Affordable Care Act eliminated discrimination based on gender and pre-existing conditions, but certain age groups and those who smoke may still pay more for insurance. Additionally, if you or members of your household are eligible for employer-sponsored healthcare then you’ll need to complete an Employer Coverage Tool for each person who qualifies even if no one in your household participates in job-based insurance. Make sure that you provide any additional documentation that you feel is necessary for determining your plan options and pricing; it’s better to be over-prepared in this situation.
What Are Your Options If You Do Not Want To Sign Up For Obamacare?
Under the law, every legal citizen who doesn’t qualify for an exemption must obtain health insurance. How can you tell if you qualify for an exemption? Here’s a list of commonly exempted groups and people who may not need to purchase healthcare using the Marketplace:
- People who obtain a plan through a private insurer
- Those who qualify for Medicaid, Medicare or CHIP
- Veterans who take advantage of TRI-CARE or VA coverage
- Those with employer-sponsored healthcare, retiree insurance or COBRA plans
In general, if you don’t file a tax return every year due to low income or you qualify for government assistance programs already then you probably won’t have to buy health insurance. However, this isn’t a hard and fast rule. You should check with the government healthcare website, one of the links on this site or a qualified Obamacare professional to determine your exemption status.
You should also note that not everyone will qualify for subsidies or cost assistance due to a variety of factors. Senior citizens and those who take advantage of Medicare will continue to sign up for and check their eligibility status through the Medicare website. And if you already have insurance through your employer, then you’ll continue to work directly with the company as you always have unless you want to enroll in a government healthcare plan during open enrollment.
Keep in mind that your coverage period begins on the first of the month following enrollment by the 15th. In other words, if you purchase a plan on January 15th then your coverage begins on February 1st so long as you’ve paid your premiums. If you enroll later in the month though, on January 18th for example, your plan will take effect on the second month, on March 1st.
Switching Your Current Health Insurance To An Obamacare Health Plan
While President Obama has stated that if you like your plan then you can keep it, he doesn’t mean to imply that you have to keep coverage that doesn’t work for your needs. In other words, if you have insurance through your employer but dislike the policy then you can switch to a Marketplace plan during open enrollment. In fact, you may be eligible for cost assistance when you switch if your employer-sponsored healthcare coverage doesn’t meet the minimum requirements under the new law. The Affordable Care Act ensures that all plans whether private, government-run or employer-sponsored meet certain characteristics, and you may qualify for subsidies if:
- Your plan pays less than 50 percent of your monthly premiums.
- The job-based insurance exceeds 9.5 percent of your family’s adjusted gross income.
- Your plan is not comparable to at least a Bronze plan on the Marketplace.
Before you switch to a Marketplace plan, research how much your employer contributes to your existing job-based coverage. You could end up losing that contribution if you switch, and the cost difference may be more than you’re willing to risk.
Options for Purchasing Health Insurance That Is Not Subsidized Under Obamacare
If you want to purchase private insurance, then you don’t need to use the Marketplace website. The health insurance exchange site offered by individual states and the federal government is primarily for people who want to take advantage of Obamacare and learn more about the Affordable Care Act in general. However, you can find private plans through several sources. In fact, thanks in part to the new laws you’re much more likely to find much better quality as well as affordable plans in the private sector today than you were a few years ago before the implementation of the ACA and its ten essential benefits.
Before you give up on the Marketplace, consider calling one of the healthcare representatives or visiting a professional in person or having a licensed health insurance agent come to your home or workplace. The Affordable Care Act is more than a thousand pages long and professionals have been trained in the new laws to help you make sense of your rights and responsibilities. Discuss your concerns and problems with these people so that you can make a more informed decision about your health insurance needs. Other options include:
- Visiting an insurer directly
- Speaking with a qualified provider
- Utilizing an insurance agent or broker
- Asking for help from friends and family
- Contacting Medicaid if you qualify
State marketplaces offer help for free, and many providers and insurers offer complimentary assistance when choosing a healthcare plan. Like travel agents, insurance brokers and agents get paid by their respective companies rather than directly from you. This means that they’ll generally offer sound guidance based on your situation instead of trying to sell you unnecessary coverage. Because they don’t earn commissions like salespeople, insurance brokers may provide the insight and information you need without the hassle of a high-pressure sales team.
Insurance agents can also help you understand eligibility requirements for cost assistance, subsidies and government programs like Medicaid or CHIP. Some people find it helpful to discuss these issues in person, and a broker can provide real-time assistance with some of the trickier aspects of Obamacare enrollment. Plus, they can point you in the right direction when it comes to coverage because they communicate directly with a variety of providers.
Speaking with a provider directly may be a great option if you know the type of coverage you want or the company you want to work with. Providers can offer their plans directly to you even if they also list their plans on the health insurance exchange website.
If you end up needing cost assistance, remember that this feature is only available for people who choose plans that are offered on the Marketplace. While all plans are now regulated according to the standards set forth in the Affordable Care Act, you won’t be able to get cost assistance if you choose to purchase insurance off the Marketplace. You’ll still get the same coverage regardless of your plan, but you may pay more if you choose a non-Marketplace plan.
Cost Assistance Options If You Do Not Qualify For Obamacare
Some people neglected to sign up for health insurance because of the cost, despite that fact that one of the primary goals of the Affordable Care Act is to make insurance more affordable and cost-effective for lower and middle-income families. In reality, if you earn between 100 and 400 percent of the federal poverty line or FPL, then you may qualify for an exemption from the penalty fee. You may also be entitled to certain assistance programs like Medicaid or CHIP.
For people who don’t qualify for assistance but still can’t afford insurance, the government offers subsidies and tax credits to make insurance affordable. Subsidies help lower out-of-pocket expenses while tax credits may reduce monthly premiums. You can check your eligibility for cost assistance programs through your state’s marketplace.
If You Missed The Enrollment Deadline – Special Enrollment Considerations – Obamacare Qualifying Events
We’ve discussed briefly that there are certain conditions that could help you avoid the penalty for non-compliance and ensure that you sign up for healthcare coverage through the Marketplace despite the fact that open enrollment has ended for 2014. The government wants every American to have access to affordable healthcare, and lawmakers have offered special enrollment periods to people who may need to sign up for insurance but have missed the deadline. You may be entitled to a special enrollment period for 2014 if:
- You or someone in your household has lost healthcare coverage within the past 60 days.
- You know that you or someone in your household will lose coverage within the next 60 days.
- Your household decreased in size due to death or divorce within the past 60 days.
- Your household increased in size due to marriage, natural birth, adoption or foster care within the past 60 days.
- You moved or experienced a change in income.
- You were freed from incarceration or became a lawful U.S. citizen or resident.
- You’re an Alaska Native corporation shareholder or a member of a federally recognized tribe.
- You end up in the hospital unexpectedly or suffer a medical situation that results in temporary cognitive disability.
- You experience a major natural disaster like a flood or hurricane.
- A non-Marketplace insurance professional misled you or provided you with misinformation.
- Administrative, technical or enrollment errors prevented you from obtaining coverage.
- You were a victim of domestic abuse.
- You’re currently involved in unresolved casework.
In terms of losing healthcare coverage, there are several reasons why you might lose your insurance even if you had insurance during the enrollment period, and the government won’t penalize you for losing coverage provided that it was involuntary or beyond your control. Reasons could include a change in work, divorce, a private policy’s ending, expiration of COBRA coverage, age limitations and losing eligibility for CHIP or Medicaid.
For example, a young adult might be covered under his parents’ insurance until his 26th birthday in July of 2014. At this point, he no longer qualifies for his existing coverage but still needs insurance under the law. Since he’s already missed open enrollment, he may be able to enroll in a Marketplace plan using the special enrollment provision because he became ineligible for his existing coverage between enrollment periods.
If you think you qualify for a special enrollment period, then contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) for further assistance. A representative will gather detailed information from you, and the Marketplace will determine whether you qualify for an extension or not. If you’re denied the special enrollment period, then you can appeal the process in writing. Once overturned, you can obtain coverage back to the date when you were denied special enrollment.
Continuous Affordable Care Act Enrollment – Obamacare Exceptions and Penalties
Even if you don’t qualify for a special enrollment period and you lack healthcare, certain circumstances may allow you to enroll in a Marketplace plan at any time throughout the year. Small businesses, people who qualify for Medicaid or CHIP, members of federally recognized tribes and Alaska Native shareholders can all sign up for Marketplace insurance at any time without regard to enrollment restrictions. In addition, you can always sign up for private or employer-sponsored healthcare whenever these plans are offered.
When it comes to Medicaid and CHIP, you can enroll in coverage up to two months retroactively if you find out that you qualify for government assistance programs. And while you can enroll in private or employer-based insurance programs when they’re available, you will still be considered non-compliant for months in which you lack healthcare coverage.
What happens if you ignore the ACA and neglect to sign up for healthcare or file for an exemption? Unfortunately, you will face a fine for non-compliance if you refuse to sign up for some form of approved insurance. Obamacare works on the premise that every legal citizen of the United States who’s eligible to buy insurance will contribute his or her share to the program. This idea falls under the “individual mandate,” and there’s a penalty for failing to comply with the healthcare law. When you file your taxes in April, you’ll be assessed a penalty fee of $325 per uninsured adult or $162.50 per uninsured child int he family or two percent of your income (whichever is greater) as an individual. The amount increases for families and continues to increase every year.