Health Insurance Deadline Passes for Most, but There Are Exceptions

THE last chance to sign up for health insurance this year under the Affordable Care Act passed on Thursday, when an extended deadline for enrollment expired.

While most people will have to wait until the next open enrollment period in the fall, there is an exception for those who have a change in circumstances — like losing your health coverage because of the loss of a job, or getting married or having a baby.

The official end of the open enrollment period for coverage was Feb. 15. But the federal government announced a special enrollment period that extended the deadline until April 30 because many people did not understand that they would have to pay a penalty for failure to get coverage before the deadline.

The reality hit home only when they filed their 2014 income taxes, which asked about health coverage and, for the first time, assessed a penalty.

Thousands of people took advantage of the extended deadline, which was available through — the federal marketplace — as well as through most state-run marketplaces. Some state marketplaces set different deadlines — Vermont’s isn’t until May 31, for instance — so it is best to check with the exchange in your state, according to the health care enrollment coalition Enroll America.

The federal Centers for Medicare and Medicaid Services, which oversees the federal exchange, said that as of April 13, about 68,000 people had signed up under the extension.

Among other reasons for eligibility for a special enrollment exception are a change in income or a release from prison. Cathy Kaufmann, enrollment program director for Families USA, an advocacy group, said that many people did not realize that moving to a state that does not offer your current plan also qualifies as reason for signing up outside the open enrollment period.

If you do become eligible for coverage for any reason during the remainder of the year, it makes sense to take a look at available plans. Penalties for not having coverage are getting stiffer, said Karen Pollitz, a health policy expert with the Kaiser Family Foundation, a nonpartisan research group

For instance, in 2014, the penalty for a single person was a minimum of $95 or 1 percent of income (income over a threshold of about $10,000 is used to calculate the penalty), whichever is larger. For someone making $40,000, that means a penalty of about $300.

For 2015, the penalty based on the same salary increases to at least $325 per person or 2 percent of income, totaling about $600.

(The penalty is capped, based on the average cost of a bronze-level insurance plan — about $2,400 for a single person for 2014.)

Ms. Kaufmann of Families USA suggested that consumers try an online tool created by the Tax Policy Center to estimate their penalty.

She also noted that applications for Medicaid, the federal-state health plan for people with low incomes, are accepted year round.

It is possible that a few insurers may sell individual plans outside the exchange and without a special eligibility requirement, said Nate Purpura, a spokesman for web-based insurance broker eHealth. One example is Meritus, he said, a cooperative nonprofit insurer that offers the plans in Arizona.

Here are some questions about coverage and enrollment periods:

■ If I didn’t sign up for coverage by April 30, will I owe a penalty for 2015?

You’ll generally owe a penalty at tax time next year for each month of this year that you lacked coverage. The penalty is prorated. You’ll owe one-twelfth of the penalty for each month you went without health insurance. If you qualify for enrollment because of a special circumstance and sign up for coverage, your penalty will be reduced.

■ Are there any exemptions to the requirement to have health insurance?

Yes. You can avoid the penalty if you qualify for an exemption like having very low income or being a member of an Indian tribe. A complete list is available on

■ When is the next open enrollment period?

The next open enrollment period begins Nov. 1, 2015, and ends Jan. 31, 2016.

Source Link

Recommended Articles

AI in Healthcare: Calls for Stricter Standards Amid OpenAI Leadership Shuffle

Recent disruptions in OpenAI’s top brass have sparked intense dialogue within the healthcare sector, emphasizing the urgent need for robust standards governing the implementation of generative AI technologies. With Microsoft recruiting former OpenAI executives Sam Altman and Greg Brockman, concerns are growing that few corporations may soon dictate the trajectory of healthcare AI, potentially molding ...

Read More

2024 FSA, HSA, and HDHP Plan Limits

A health Flexible Spending Account (FSA) is an employer-sponsored benefit that allows eligible employees to save pre-tax dollars to pay for qualified medical expenses. Employees can elect a specific dollar amount, up to a certain limit, to set aside annually.

Read More

Proposals On PBMs And Medical Devices Advanced By House Subcommittee

The House Committee on Energy and Commerce health subcommittee pushed forward 21 proposals on Tuesday, some of which will restrict the power of pharmacy benefit managers (PBMs). Democrats supported many of the proposals put forward by Republicans, including legislation reining in PBMs that had support from 60 organizations representing patients, providers, pharmacists, small businesses and ...

Read More

CMS Tightening Network Adequacy Standards For Exchange Plans

Beginning in 2025, health plans sold in state-run insurance exchanges would be required to meet time and distance standards that are at least as adequate as mandated on federal marketplaces, according to a rule released by the Centers for Medicare & Medicaid Services (CMS) on Wednesday. Time and distance standards would be calculated at the ...

Read More