It’s vital consumers understand importance of Open Enrollment period

Last updated: July 27. 2014 6:31AM - 609 Views
By Eve Black-Venters Guest columnist

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On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act(ACA) or “Obamacare.” This new law required that most people have health insurance coverage by Jan. 1, 2014. Although some individuals may qualify for an exemption, most people not meeting the requirement will invoke a penalty in the form of a tax. This penalty will increase annually over the next few years. The intention of the law is to lower health care cost and improve the overall quality of health care. Although health care reform may differ from one person to another, the law requires that health insurance companies update their plans to include certain protections. As a result, there are many value added insurance benefits from the health care reform law. A few examples of the added benefits include: no annual or lifetime dollar limits; expanded, no cost preventative health care; access to health coverage regardless of pre-existing health conditions. The Affordable Care Act encompasses many issues and it is important that each person explore his or her options.

Most individuals who are eligible to enroll in a qualifying health insurance plan must enroll during an Open Enrollment period. In 2014, the proposed Open Enrollment period will run from Nov. 15, 2014, until Feb. 15, 2015. During this time, individuals as well as families may apply for health coverage on or off the Health Insurance Marketplace. It is important that consumers understand the importance of the Open Enrollment period and understand that when applying outside of the Open Enrollment period, generally, a special election period must be granted. Some examples of a special election period may include but are not limited to marriage, a new baby, an adoption, a change in residence or involuntarily loss of one’s health coverage. It is important to understand that although there are private, family and individual plans sold outside of the Open Enrollment period such as gap coverage or short term health insurance coverage, these plans do not always protect one from the penalty. Products such as short term or gap coverage are not considered minimum essential coverage.

In many cases, the Health Care Reform Act offers consumers lower cost health insurance as well as cost sharing for those who qualify. An individual may qualify for Advanced Premium Tax Credits(APTCs) that lower their monthly premiums or cost share subsidies that lower co-pays, deductibles and coinsurance. These plans are broken down into four categories; bronze, silver, gold and platinum. Each plan meets the required minimum essential health coverage mandated by the Health Care Reform Act. In order to receive an Advanced Premium Tax Credit(APTC) or subsidy, an individual must go through the Insurance Marketplace. Advanced Premium Tax Credits(APTCs) and subsidies have guidelines that the Marketplace will use to determine premiums and benefits. In many cases, insurance agents and brokers are certified with the Marketplace and can help assist you in applying for coverage and finding out if you are eligible for Premium Tax credits or a subsidy. Navigators may be available in your area to assist you. You may also enroll online or call the Health Insurance Marketplace at 1-800-318-2596.

(Eve Black-Venters is a certified senior advisor and ower/agent with Eve Black & Associates/Black & Associates Insurance.)

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