Got Coverage?

A local insurance rep breaks down everything you need to know about getting insured under the Affordable Care Act.

  • Category
    Health
  • Written by
    Diane Cruz

Open enrollment for 2016 has been well underway since November 1, and under the Affordable Care Act, everyone must have health insurance or face a penalty. During open enrollment, anyone can purchase health insurance. However, outside this period you cannot purchase health insurance unless you have a special qualifying event. 

If your employer or spouse’s employer does not provide health insurance, you will need to buy it in the private marketplace or Covered California (coveredca.com). If you qualify, Covered California may provide you with assistance toward your health insurance premiums.

You will have the option to renew your current health plan during open enrollment. However, this is also a great time to shop across all health insurance company plans. You may not be aware of changes to your benefits, if your doctor is leaving your network or if your medications are covered at a different cost.

If you do not sign up for a health plan in 2016, you face a fee of 2.5% of your yearly household income, or $695 per person ($347.50 per child under 18). You’ll have to pay whichever number is higher. If you don’t enroll during open enrollment and would like to purchase health insurance in 2016, you must qualify for a special exception. You will have 60 days to enroll from the date of that event.

Qualifying events that trigger a special enrollment period are marriage, divorce, birth or adoption of a child, death of a spouse or partner that leaves you without health insurance, losing company-sponsored health insurance, a reduction in work hours, or having an HMO and moving outside its coverage area. 

It is important to note: If you voluntarily drop your coverage, you won’t qualify for a special enrollment period. The only time you can re-enroll is during the next enrollment.

Here are some key dates you should know:

•    Enroll between November 1 and by December 15, and your coverage will be effective January 1, 2016.

•    Enroll between December 16 and January 15, and your coverage will be effective on February 1, 2016.

•    Enroll between January 16–31, and your coverage will be effective March 1, 2016.

 

You will not have to buy health insurance if you have credible health insurance elsewhere, such as an employer-sponsored company plan, veteran benefits or Medi-Cal. Other exemptions are if you are a member of a federally recognized Indian tribe, member of a health care sharing ministry or member of a recognized religious sect with religious objections to insurance.

If you suffer a hardship you can check with a qualified insurance agent to see if you can be exempt from enrollment. Other forms of exemptions are if you are incarcerated or you are a U.S. citizen living abroad.

Health insurance rates are set by law, so utilizing the services of an insurance agent should not cost an additional charge. Look for unbiased, independent, free advice. Be smart. Be informed. Be covered!