We have been receiving a high amount of phone calls regarding this year's PPACA Open Enrollment. We are currently reviewing all of the products and rates for the 2016 plan year. As part of this review, we will be illustrating what we believe are the top carriers both on and off the Health Insurance Marketplace (HIM) for your benefit. We are hoping to have this work completed by mid-October so we can hit the ground running for the 11/1/15 start date of Open Enrollment. Once we have completed our work, we will be reaching out to our client base to discuss the alternatives for 2016.
Here are some important dates and information you need to know prior to this year's Open Enrollment season:
- Open Enrollment Timeframe
- Open Enrollment for Individual/Families is 11/1/15 through 1/31/16
- Enrollment Timeframe for 1/1/16 Effective Date
- You must enroll between 11/1/15 and 12/15/15 for a 1/1/15 effective date
- Enrollment Timeframe for 2/1/16 Effective Date
- You must enroll between 12/16/15 and 1/15/16 for a 2/1/16 effective date
- Enrollment Timeframe for 3/1/16 Effective Date
- You must enroll between 1/1/16 and 1/31/16 for a 3/1/16 effective date
- 1/31/2016 - Open Enrollment closes for the 2016 calendar year. If you do not secure individual coverage for your self by this date you will have to wait until 01/01/2017 to enroll in coverage unless you have a "Qualifying Event"
Mandated Penalties for Not Enrolling
If you fail to enroll in health insurance , do not have group health insurance through your employer/your spouse's employer, have Medicaid/Medicare, or have health insurance through COBRA during 2016 you may be subjected to the following penalties:
- Single Person - $695 or 2.5% of your adjusted gross income (whichever is higher)
- Two People - $1390 or 2.5% of household adjusted gross income (whichever is higher)
- Family (3 or more people) - $2085 or 2.5% of household adjusted gross income (whichever is higher)
How to Determine Your "Modified Adjusted Gross Income" (MAGI)
In short, your "Modified Adjusted Gross Income" (MAGI) is your income less any qualified deductions. We understand that every situation is different with respect to MAGI so we have provided you with a very simple, one page document to assist you:
Do You Qualify for an "Advanced Premium Tax Credit" (APTC) and/or "Cost Sharing"?
In general, if you make less than 400% of the Federal Poverty Limit (FPL) you may qualify for an Advanced Premium Tax Credit (APTC) to help pay your premiums each month. Here is a simple chart to illustrate what income level you need to be at to qualify:
PLEASE NOTE: if you have income between 150% and 250% of the Federal Poverty Limit (FPL) you will qualify for Cost Sharing which will further reduce your out-of-pocket expenses.
Get a Head Start...
We only have 90 days each year to try to address every client during Open Enrollment. As you can imagine, this is very challenging when we are talking about thousands of people :)! If you are happy with your current plan and premium you can simply keep it as long as you have not received a letter from your carrier stating that it has been discontinued.
However, if you would like to get a "Head Start" with your Altruis Benefit Advisor please do the following:
- CLICK HERE to access the "Do I Qualify?" page on our company website
- Please complete all the required fields
- Please select your Benefit Advisor from the drop down list provided
- If you do not have a Benefit Advisor please select "I do not have an advisor"
- Click "Calculate"
Your Altruis Benefit Advisor will review your information, calculate your approximate Advanced Premium Tax Credit (APTC), and contact you to discuss your 2016 plan options. This is a great way to get ahead of the game and it allows us more time to work with you and answer any questions or concerns you may have.
As always, we sincerely appreciate the opportunity to assist you with your health insurance needs! You can contact the professionals at Altruis Benefit Consulting using the information below if you have any general concerns about your coverage, Open Enrollment, or Health Care Reform in general. We look forward to hearing from you!