Health Care MarketplaceNews & Research

Missed Open Enrollment? Here Are Two Great Options

Open Enrollment for 2016 has ended. However, if you missed the deadline you still have options:

Get a cheaper alternative to Obamacare with Short-Term Insurance.

What is Short-Term Health Insurance? Short-term insurance is great if you:

  • Need coverage and Open Enrollment has ended
  • Need coverage immediately (coverage can start the next day)
  • Don’t have a pre-existing condition
  • Don’t have a qualifying life event
  • Need a plan for less than 12 months
  • Acknowledge that you understand that short-term plans do not comply with the individual mandate under the law

Plans can start as low as $50 per month.

View Short-Term Plans


If you had a “qualifying life event” you can still enroll in Obamacare/ACA insurance and receive subsidy discounts.

What does this mean? If you had a “Qualifying Life Event” you are allowed to enroll in health insurance outside of the Open Enrollment period. If you experienced one of these events in the last 60 days, you can enroll in a plan up until the 60th day after the event occurred:

  • You got married or divorced
  • You had a child or adopted a child
  • You turned 26 yrs old and will lose coverage on your parent’s plan
  • You lost health coverage from your job
  • You moved locations and your insurance is no longer offered
  • You had a change in income (and are now eligible for a bigger or smaller subsidy)
  • View more Qualifying Life Events
View Obamacare Plans



2017 Open Enrollment Deadlines

The Open Enrollment period for Obamacare health insurance in 2017 is November 1, 2016 to January 31, 2017. Critical deadlines are:

  • November 1, 2016: Open Enrollment begins. Apply for or change your coverage.
  • December 15, 2016: Deadline in order to have coverage that begins on January 1, 2017 (if you apply on December 16 you’re coverage will most likely not start until February 1).
  • December 31, 2016: Coverage ends for 2015 plans. You will be auto-renewed if you don’t change your plan.
  • January 31, 2017: This is the last day you can apply for 2017 coverage before the end of Open Enrollment.

If you miss this window you cannot enroll until the Marketplace re-opens in November 2017 unless you have a special “life event” such as having a baby, getting married or losing your coverage through your employer. This is designed to prevent people from taking advantage of the system by enrolling and dropping insurance multiple times a year when they only get sick.

If you don’t enroll in Obamacare in 2017, you’ll be fined 2.5% of your income or $695 per adult, whichever is higher.

Individuals and children living in poverty can enroll at anytime in Medicaid or the Children’s Health Insurance Program (CHIP). There is no enrollment period for these programs, but there are income restrictions and other qualifiers.

Coverage start dates

If you enroll before the 15th of any month, your coverage starts the first day of the next month. If you enroll after the 15th of the month, you’ll have to wait until the month after that for your coverage to start. For example, if you enroll on January 16th, your coverage will begin on March 1st.

Visit here for information on 2016 Open Enrollment deadlines..

Avoid Serious Risks And Enroll Before The January 31 Deadline

The Department of Health and Human Services (HHS) has announced from Nov. 1, 2015 through Jan. 20, 2016, an estimated 8.8 million people had enrolled in Obamacare/ACA insurance in the 38 states that rely on the federal exchange and another 2.7 million that use state-run exchanges (and the District of Columbia). Open Enrollment ends on January 31 and if Americans miss this deadline there are stronger penalties and risks than in previous years.

4 Risks To Not Enrolling By January 31:

Tax penalties – By not enrolling by 11:59 p.m. on Jan. 31, you could face IRS-imposed tax penalties. Some consumers may avoid these if they qualify for hardship exemptions. But if found liable, you’ll pay the greater of:

  • $695 per adult and $347.50 per child, for a maximum of $2,085 per family; the 2015 penalty was $325 per adult and $162.50 per child
  • 5 percent of your income above the tax filing threshold; the 2015 penalty was 2 percent

Read more here: Obamacare tax penalty.

Inability to purchase coverage – Not enrolling may prevent you from being insured later on. You may be able to enroll outside of the OEP, during a Special Enrollment Period (SEP), if you experience special life changes, known as Qualifying Life Events (QLEs); e.g., childbirth, loss of coverage, relocation. However the government has recently announced new restrictions that will make it more difficult to enroll for an SEP.

Short-term health insurance – Consumers may have to turn to short-term (or temporary) policies, which are meant for shorter periods (1-12 months). But they only cover emergencies, whereas traditional plans provide preventive care, physicals and immunizations. They do not meet the ACA’s benefit standards, so you could still face tax penalties. Short-term plans are not eligible for government subsidies. Pre-existing conditions are not covered, and you may be liable for coverage gaps if you switch to a traditional plan.

Out of pocket – Paying all medical expenses yourself can be very expensive. In 2014, uninsured low- and middle-income, nonelderly adults were twice as likely as those who gained coverage or had coverage to have problems paying medical bills. They were more likely to use up savings, have problems paying for necessities, borrow money or have medical bills sent to collection.

CMS: New Rules Restrict Enrolling Outside Open Enrollment Period

The Open Enrollment Period for 2016 ends on January 31, however the Centers for Medicare and Medicaid Services (CMS), the agency responsible for the nations’ healthcare, allows individuals with special ‘life events’ to enroll outside of this period, known as Special Enrollment Periods (SEPs). The SEPs are very successful, with about 944,000 beneficiaries enrolling last year between Feb. 23 and June 30, 2015.

The time and need for SEP changes

Recently, the government has announced some adjustments to the SEPs, redefining the definitions and rules. According to a Jan. 19, 2016, memo, written by Kevin Counihan, the CMS’ Director and Marketplace Chief Executive Officer, these changes were necessary, due to multiple factors. First, there were the needs of insurance carriers, who are crucial to the ACA’s well-being. It was also determined that some beneficiaries were taking advantage of the SEPs. The large number of consumers unable or unwilling to meet the OEP’s deadlines made these changes vital, as well.

Meeting carriers’ requests

While the CMS may offer official SEPs, the agency has been eliminating some of these, at the request of insurance carriers. For example, the CMS put an end to the Tax Season SEP, which ran from March 15-April 30, 2015. This SEP was originally meant for 2015 alone, though. But the Jan. 19 memo revealed that another six SEPs will be eliminated, including those for:

  • Consumers who enrolled with too much in advance payments of the premium tax credit because of a redundant or duplicate policy
  • Consumers affected by an error in the treatment of Social Security Income for tax dependents
  • Lawfully present non-citizens affected by a system error in determination of their advance payments of the premium tax credit
  • Lawfully present non-citizens with incomes below 100 percent FPL (federal poverty level) who experienced certain processing delays
  • Consumers eligible for or enrolled in COBRA and not sufficiently informed about their coverage options
  • Consumers previously enrolled in the Pre-Existing Condition Health Insurance Program

Addressing system abuses

In regard to possible abuses of the SEPs, the CMS wanted to educate beneficiaries, brokers, issuers and other involved parties by better defining certain eligibility guidelines. Specifically, the agency provided guidance for the SEP dealing with consumers who had permanently moved and gained access to new health plans. The CMS stated that these consumers cannot use the SEP for short-term or temporary moves, where they wouldn’t stay in their new locations. For example, these moves included being admitted to hospital for treatment in different areas.

Enforcing the rules

The last factor involved the enforcement and understanding of the SEPs’ specific rules and requirements. The CMS will be performing an assessment to determine whether consumers that purchased policies during certain SEPs did so properly. This will involve the agency’s program integrity team examining national samples of consumer records and possibly requesting other information.

The CMS believes that these findings will help them to better plan for the future and make necessary improvements.  In addition, the CMS will stress the need for applicants to provide accurate information. Those who intentionally provide false or untrue information may be subject to penalties under federal law.

The role of QLEs for enrollment extensions

When Special Enrollment Periods are permitted, they allow consumers to enroll in ACA-compliant plans outside of the traditional time window. This spares people otherwise in need from expensive tax penalties. In most cases, SEPs are granted to those individuals who may have lost their coverage or are experiencing certain life changes, known as Qualifying Life Events (QLEs). For individuals qualifying for their own SEPs, these typically begin 60 days after a QLE. However, you may enroll up to 60 days before, preventing coverage gaps. Examples of QLEs include:

  • Childbirth, adoption, foster care –Provided you enroll within the 60-day period, new coverage starts on the day of the birth, adoption, or placement.
  • Marriage –As long as someone marries on or before Nov. 30 of a given year, they can enroll in coverage starting on Dec. 1. However, getting married Dec. 1 or later requires filling out an application for the following year; coverage will start on Jan. 1. The marriage rules also apply to divorce.
  • Loss of coverage –If you leave your job, or lose any coverage on or before Nov. 30, you can enroll in a plan that starts Dec. 1. These requirements apply to ACA-compliant, employer-sponsored, private and COBRA plans. The new plan must be selected on or before Nov. 30. Coverage lost Dec. 1 or later requires an application for the next year, with coverage starting Jan. 1. It should be noted that this QLE doesn’t apply if you voluntarily give up other coverage or are terminated for not paying premiums.
  • Minimum essential coverage – Coverage lost not considered to meet the ACA’s individual responsibility requirements doesn’t apply; the uninsured fee isn’t required either. Among those policies affected are Marketplace and private policies, Medicare, Medicaid, CHIP and TRICARE, healthcare for active-duty and retired uniformed services members and their families.
  • Medicaid or CHIP changes – Those found ineligible for Medicaid or the Children’s Health Insurance Program (CHIP), the joint federal-state health insurance program for low-income children.
  • Marketplace plan changes, this includes not being enrolled, enrolling in the wrong plan and related plan contract violations.
  • Changes in income affecting payment for coverage, such as qualifying or disqualifying for subsidies. This includes those newly determined to be eligible or ineligible for advance payments of the premium tax credits or cost-sharing reductions.
  • Experiencing domestic abuse, violence or spousal abandonment
  • Hardships preventing enrollment, such as natural disasters or serious medical conditions occurring during the OEP
  • Changes in citizenship, including gaining status as a citizen, national or lawfully present individual. In particular, this impacts those gaining or maintaining status as members of a federally recognized tribe or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
  • Relocating to a new state, including states that haven’t expanded Medicaid or those with new Marketplace plan options.
  • Leaving incarceration

Obamacare Open Enrollment Ends Jan. 31; Stiffer Penalties For Uninsured

Less than 2 weeks are left for 2016 Obamacare Open Enrollment and Americans will face much stiffer tax penalties for not having insurance this year.

In 2016 the penalty is $695 per adult and $347 per child up to a family cap of $2,500 or 2.5% of household income, whichever is greater. This is a large leap over least year’s penalty of $325 for adults, with a $975 maximum or 2% of household income. This is a real penalty that can have a large impact on the bottom line for consumers when they file their tax returns. A recent study from the Kaiser Family Foundation found that the average penalty will balloon from $661 per adult in 2015 to $969 in 2016; a real shock for those that aren’t aware of the new health law’s implications.

According to the IRS, 7.5 million Americans paid a total of $1.5 billion in Obamacare tax penalties on their 2015 returns for failing to have insurance in 2014. That year, the fines assessed were only $95 per adult or 1% of household income (whichever was greater).

2016 Obamacare tax penalty

As part of the Affordable Care Act, Americans are required to have health insurance. This creates a larger pool of consumers which intends to generate lower health care costs and provides for government “subsidies” to lower income individuals to significantly lower the cost of their insurance.

Paying for health insurance is likely a better option than paying the tax penalty and possibly tens of thousands in medical bills for any accidents that may occur while uninsured. The real question will be if the higher tax penalty will help motive uninsured consumers to enroll in a health plan if they haven’t already.

Open Enrollment ends on January 31, 2016 and Americans can avoid the tax penalty by enrolling in a plan by that date. Extensions are not expected to be offered this year so this deadline is very important to keep in mind.

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