March 6, 2014
Unlike in previous years, you cannot sign up for an individual insurance plan at any time in 2014. There are health insurance deadlines now.
The open enrollment period ends on March 31st – this means that you either have to be signed up on healthcare.gov for a plan or have an application submitted directly to an insurance company by this date in order to avoid any fines from the Individual Mandate. If you sign up by March 15th, you will have coverage starting April 1st. If you sign up by March 31st, coverage will start April 1st. In 2014, your plan year would only last until 12/31/2014 so all deductibles and maximum out-of-pocket limits would reset on 1/1/15.
Special Election Periods
If you currently have insurance and are concerned about losing benefits sometime after 3/31/14, do not fear. If you have a “qualifying event” in your life, you will have a 60 day special enrollment period to enroll in a new health insurance plan through healthcare.gov or directly with an insurer.
Qualifying events include getting married, getting divorced, having a child, moving out of your insurer’s coverage area, or losing your current coverage through your employer or another government policy. This Special Election Period lasts for 60 days from the time of the qualifying event. A good resource sheet for this topic is at the Marketplace website.
Plan Adjustments Throughout the Year
You cannot change your plan choice during the year, but you can add/drop dependents due to marriage/divorce/birth/adoption. You should also adjust your estimated income at healthcare.gov if your projected income changes so that your original estimate is no longer accurate. This will prevent you from having to pay back subsidies at the end of the year if you make more than estimated…and get a higher subsidy if you are making less than estimated.
If you did not originally qualify for subsidies but see a loss in estimated income, you may become eligible to start receiving subsidies. Also, since Pennsylvania has not yet expanded Medicaid, people making less than approx. $11,500 do not qualify for government help and have to pay full price on the Marketplace.
Should you gain an additional income source, such as a new job, and will end up making at least $11,500 per year, you can change your income at healthcare.gov and actually start receiving subsidies.
Next Open Enrollment Period
The next proposed open enrollment period is from November 15th, 2014 –January 15th, 2015. During that time you can change plans for 2015 – hopefully we will have some final answers on UPMC vs Highmark at this time. After December 15th, you will not be able to change your plan (outside of a Special Election Period) until the following year’s 10/7 – 12/15 open enrollment period.
Obviously, this is all very confusing. Key takeaway: If you are uninsured, call us ASAP so we can help you get all signed up before the end of March! If you then need help changing your plan or getting enrolled because of a qualifying event, call us at that time!