It's that time of year again! Open enrollment for state-run Health Insurance Markets will open shortly. This means that if you are self-employed, a contractor, a small business owner (or employee), or unemployed, now is the time to begin researching health care plans for 2017 to avoid a last-minute, frantic rush to enroll -- or worse, missing the deadline and facing steep financial penalties when filing your 2017 taxes.
Enrollment Begins November 1, 2016
Tuesday, November 1, 2016, will be the first day that you can log onto a Marketplace site and enroll in a new plan (or change your existing plan to one that better suits your needs or budget). That coverage, depending on payments and the plan selected, can become effective as early as January 1, 2017. You will have the entire month of November and the first fifteen days of December to select and enroll in a healthcare plan. If you have not selected and enrolled in a plan by the 15th of December, 2016, you can still do so, at least until January 31, 2017. However, obviously, for those who wait until late December or the month of January to enroll, coverage will not begin until later in the year. For those who do not enroll by January 31, financial penalties may apply when the time comes to file taxes for the year of 2017.
Coverage generally starts at least 30 days after the payment of the first premium, and billing is generally on a monthly basis. It is important to understand that you will be expected to pay your premium before the policy is active. Failure to pay will result in your policy not being made active or even being canceled if payment lags for more than a month (depending on the insurance provider).
What Are the Penalties for Not Enrolling?
For many working-class families, even subsidized health care plans available via the Marketplace may result in some financial strain. In 2015, the fee that was assessed at tax time for individuals who did not have healthcare was either $325 per person or 2% of the individual's annual income (whichever was higher). Those who did not have health insurance for more than three months of 2016 will be penalized to the tune of $695 or 2.5% of their annual income (again, whichever is higher). At this time, the government has not released the exact penalty information for those who do not carry coverage in 2017.
Unless you meet the stringent requirements for a waiver, these penalties are universal. Every single taxpayer in the United States is subject to the fees and penalties, unless they belong to certain protected groups (such as Native American tribes and Native Alaskan tribes or religious organizations that reject modern medicine), were homeless, had utilities shut off, experienced domestic violence, or were the victim of a flood, fire, or other natural or man-made disaster. Some exemptions are also offered for those awaiting an appeal on a previous issue with Marketplace insurance or those who care for an elderly or disabled family member. In short, only those in dire financial straits qualify for an exemption from the requirement to carry health insurance.
How Much Do Marketplace Healthcare Plans Cost?
Starting at the Bronze level, there are individual coverage plans that can cost as little as roughly $68, if the individual applying qualifies for assistance or a subsidy. The bronze plans typically have lower amounts of coverage, high deductibles, and copays as well as co-insurance. From there, the plans increase to the Silver and Gold levels, which tend to offer better coverage and more affordable copays and deductibles, although they enforce higher monthly premiums (often over $100). Each of these plans should be closely reviewed to ensure they offer coverage for care you or your loved ones expect to require in the upcoming year, from prescription coverage to mental health care coverage.
For dental and vision insurance, there are separate plans available for substantially lower monthly premiums. These plans range widely in price, but can cover a variety of services, from regular checkups and examinations to eyeglasses or contacts and tooth extraction. Dental plans typically do not cover orthodontia, unless the issue is extreme and poses health risks. For many individuals and families, these policies can easily pay for themselves if any dental care or vision screening or assistance devices are required.
Why You Should Sign Up
Of course, the most pressing and easily argued reason to sign up for a Marketplace healthcare plan is to avoid those penalty fees handed out to those who don't provide evidence of health coverage for at least ten of the twelve months in a calendar year. Those fines, however, aren't the only reason why you should give serious consideration to signing up for a Marketplace Health Plan.
First of all, especially if you qualify for income-based subsidies for your plan, these plans are often much more affordable than those offered directly by healthcare companies or even some employers. This means that, for as little as under $70 per month, you are able to carry healthcare coverage that will protect you from certain financial ruin if you become ill or suffer a physical trauma such as a vehicular accident where you are at fault and receive no coverage from the car insurance company.
Finally, there is the peace of mind that comes with knowing that, even if you're young and healthy, you can have immediate access to necessary medical services if something unexpected or tragic happens. While hospitals are required to provide life-saving services regardless of someone's ability to pay, the interpretation of that concept is strict and is generally limited to immediate trauma response and one-shot, life-saving procedures. Those who would require ongoing treatments or medications but do not have healthcare coverage can often be left to their own devices, without access to treatments and medicines that could save or extend their lives. Don't gamble with your health; mark your calendar for open enrollment and ensure that if you need it, you have coverage for the care you need!