On the cusp of going into the second year of the ACA, or Obamacare, I’d like to give you an overview of what will commence on November 15th and end on February 15th for all individual health plans in our healthcare marketplace.
Important Individual Healthcare Coverage Deadlines
“Open Enrollment” for all individual health coverage begins on November 15th. If you have an individual “on” or “off” exchange health insurance plan, now is the time that you can elect to change your coverage and accept a new 12-month rate guarantee effective January 1, 2015. If you are not currently on a health plan, now is also the time for you. There are 4 factors used in determining the cost of your coverage; (1) you and your dependent’s ages, (2) your zip code, (3) if anyone is a smoker, and, (4) the richness of the plan you intend to purchase.
If you currently purchase your health insurance coverage “On-Exchange”, meaning through the Nevada State Exchange, or, would like to in 2015; from November 15th through December 15th, you can purchase a health plan that would go into effect on January 1, 2015. If you purchase a plan from the 15th of December through the 15th of January, your coverage would begin on February 1, 2015. Lastly, you can purchase a plan from January 15th through February 15th for a March 1, 2015 start date. We will navigate with you at HealthCare.gov, verify that you qualify for a subsidy, and assist you in electing a plan. We have not seen the plan offerings for 2015 yet, but it should be noted that the plans offered in 2014 were HMO’s only. We must be able to estimate your 2015 household income so that we can determine the level of subsidy you qualify for. We need to be as accurate as possible, as under estimating your income would result in you having to pay back the amount of subsidy you should not have received.
Should you choose not to purchase a plan during the “Open Enrollment” period, you would only have the opportunity to purchase a new plan if you were to lose coverage elsewhere. The start date would be the first of the month following the completion of the application and making the first payment. After March 1st, remember, the only other opportunity to purchase insurance through the exchange, would be if you were to have lost coverage.
You can also elect to purchase your coverage “Off-Exchange”. If you want a PPO, or feel you wouldn’t qualify for a subsidy, we can get quotes for you, your family, or employees from all the available carriers. This policy would go in effect on January 1, 2015, if you were to purchase a plan between November 15th and December 15th. Should you elect to not purchase the coverage, you would still be able to purchase a plan in January for a February 1 start date and in February for a March 1 start date. After the March 1st deadline, should you elect to purchase coverage at any other time in 2015, the coverage you buy would not go into effect until the first of the month following 90 days. However, if you were to have a non-voluntary loss of coverage any time throughout the year, you would have a 30-day “qualifying event” right to purchase a plan the first of the month following the date your coverage ended. Waiting longer than 30 days to act would result in you having to wait the normal 90 days.
I hope this has been helpful in explaining your options for 2015. It can be very confusing when all your choices are in a constant state of change. Everything included in this summary can change throughout the year, as new interpretations are made frequently. As I began to type this article on July 24th, two separate courts ruled that any state that utilizes the federal exchange, like Nevada, could not legally subsidize for healthcare coverage. Stay tuned, as this has yet to be resolved. I anticipate having to amend this document frequently in the next few months, so check back, as things may change.
You are more than welcome to reach out to me personally to ask any questions that you would like answers to that may or may not have been covered in this summary.