ACA Open Enrollment, Part Deux


On November 15 (and through February 15, 2015), the second open-enrollment period will begin for individual health care coverage under the Affordable Care Act. Despite a dreadful rollout, during the first Open Enrollment period, 8 million individuals signed up for non-group coverage through federal and state Marketplaces. If you didn’t sign up for coverage in the first go-round, you will be able to enroll for 2015 at HealthCare.Gov, which has been revamped for the new season. Note: If you want coverage starting January 1, you must enroll by December 15. If you signed up last year, use this time to renew or change policies and to ensure your current plan is still the best choice for you, especially if you are one of the approximately 85 percent of Marketplace enrollees who is receiving premium tax credits to make coverage more affordable. (Remember that you claim the credit by filing a federal income tax return.)

While it may seem easy to renew coverage without updating, unless you update your income data, you won't have accurate information about how much you are eligible for in tax credits and what your out-of-pocket premium contribution for a plan actually is. Additionally, if your income has increased, you may no longer be entitled to the credit, a fact that you don’t want to discover when you file taxes and have the nasty surprise of owning the government money!

Even if your personal circumstances have not changed, the cost of your plan may rise next year. PriceWaterhouseCooper’s Healthcare Institute found that on average, premiums for individual insurance plans are expected to increase by 6 percent in 2015, though actual changes and premium prices vary significantly across states.

Your cost of healthcare is not just measured in premiums, but in out of pocket expenses like deductibles, co-pays and coinsurance. All Marketplace plans are required to set a cap on total out of pocket spending for in-network services in a year. The maximum out of pocket cap for 2015 will increase to $6,600 for an individual ($13,200 for a family policy), compared to $6,350/$12,700 in 2014.

Another change for 2015 is the penalty for not having health care coverage. The fee is the higher of: two percent of your income or $325 per adult/$162.50 per child, with a maximum penalty per family of $975. You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage. If you don't pay the fee, the IRS will hold back the amount of the fee from any future tax refunds, but there are no liens, levies, or criminal penalties for failing to pay it.

According to the Kaiser Family Foundation, you may be exempt from the requirement to maintain qualified healthcare coverage if you:

  • Can not afford coverage (defined as those who would pay more than 8 percent of their household income for the lowest cost bronze plan available through the Marketplace)
  • Are not a U.S. citizen, a U.S. national, or a resident alien lawfully present in the U.S.
  • Had a gap in coverage for less than 3 consecutive months during the year
  • Will not file a tax return because your income is below the tax filing threshold (In 2014 the tax filing thresholds are $10,150 for individuals and $20,300 for married filing jointly)
  • Are unable to qualify for Medicaid because your state has chosen not to expand
  • Participate in a health care sharing ministry or are a member of a recognized religious sect with objections to health insurance
  • Are a member of a federally recognized Indian tribe
  • Are incarcerated

Kaiser also notes some exemptions must be obtained by applying directly to the Marketplace and those who may be eligible for exemptions and who have not yet applied for one can still do so before the end of the year. Some exemptions can be claimed on the income tax return with IRS Form 8965, though the exemption for people who don’t earn enough to file taxes is automatic.

Finally, if you need help, you can call the health insurance marketplace for assistance, at 1-800-318-2596, where one of 14,000 customer service representatives (an increase of 1,000 from last year), can answer questions.