Penalties Now Reach Maximum of $2085/Family
While the third annual Open Enrollment started November 1 and ends Jan 31, 2016, the current deadline for policyholders is December 15, 2015. That’s the last day changes can be made to current policies or enroll for the first time to get a January 1, 2016 effective date.
Those enrolling Dec 16 until Jan 15 will get a Feb 1 effective date; after Jan 15 until Jan 31 will get a March 1 start date. After that, only special circumstances will allow enrollment, both on or off exchange. These include a status change (marriage, divorce, adoption, childbirth) or loss of coverage. Carriers have stated that they will ask for documentation to support mid year changes starting in 2016.
Choose your plan carefully
While Healthcare.gov reported in October that 7 out of 10 will find a plan less than $75 / month and average 2016 rate increases are 7.5 percent, Habersham County and area county residents are finding different news from current health insurance carriers in their renewal and discontinuation letters.
In Habersham County, applicants choosing to use a subsidy (Advanced Payment Tax Credit) will be choosing from Alliant SoloCare, Blue Cross Blue Shield Pathways HMO, United Health Care, and Humana. Habersham Medical Center accepts all four, however, Northeast Georgia Medical Center and its affilitate physician group, does not participate in the Blue Cross Blue Shield Individual Pathways HMO product. Many current policyholders will be switching carriers this year to find lower rates.
Exemptions and penalties
The Affordable Care Act mandates that Americans keep minimum essential health insurance coverage to cover health care costs; only certain exemptions can allow persons to opt out.
In 2016 the per-person based penalty skyrockets to $695 per adult and $347.50 per child, with a maxium cost of $2,085 per family. Penalties based on household income rises to 2.5%. (2015 penalties were $325 per adult and $162.50 for children.)
Some types of hardships, including homelessness, foreclosure, eviction, bankruptcy, or the death of a member of your immediate family can qualify for exemptions. Not making enough money to file a tax return, as well as a gap in coverage of less than three months, also results in a waiver.
Insurance brokers can help
Fifty-four percent of Americans say selection of a health insurance plan is more complicated than solving a Rubik’s Cube puzzle. Last year, many applicants found themselves being asked to upload documents like payroll and birth certificates for matching purposes. In 2015, some lost their subsidy and only realized it when they opened billing statements for the full cost of the plan, rather than the difference between their subsidy and the full cost.
Georgians who try to enroll online spend an average of 117 minutes online choosing a plan
While most insurance brokers and agents may not be a whiz at solving a Rubik’s Cube, they do know how to use their training and experience to cut through the heap of hodgepodge after listening to an applicant’s health care needs and verification challenges. Furthermore, they can contrast and compare plans, pricing, and providers, as well as prescription coverage. For those who want the lowest price to satisfy the new penalties, the lower cost, narrow network plans may be a fit.
Georgians who try to enroll online spend an average of 117 minutes online choosing a plan, then, they must go through the enrollment process: 46% spend 2 hours or more.
When all is said and done, 1 out of 5 say that they are dissatisified with the experience. Requests for verification documents have particularly stressed online enrollers when the Marketplace doesn’t show records of having received the requested info.
Working with an agent or broker does not increase the cost for the applicant; it can save time and money while an agent utilizes cost-comparison tools, and streamlined and time efficient processes. Unlike navigators at the Healthcare.gov site, personalized recommendations can be suggested by a Federally-Facilitated Marketplace (FFM) certified agent or broker.
Clarification to earlier article: After review and confirmation with United Health Care, we discovered that UHC listed NGMC as a “Medical Center” in their network listing–not a hospital. NGMC is in fact, in network for the United Health Care Compass on exchange Individual plans.
ABOUT THE AUTHOR
Sherry Franklin is a Certified Senior Advisor and licensed insurance broker in GA and SC. She specializes in Individual & Group/Supplemental/Senior Plans. She’s the owner of Sherry Franklin & Associates, Inc. which has offices in Cornelia and Cleveland, GA.
