There is so much going on in our field right now, it’s difficult to know where to start. For now, we need to address the most pressing deadlines which are for individual coverage. This means coverage that is not provided through an employer-employee relationship.
While there is a lot of talk about repealing the Affordable Care Act (ACA also known as Obamacare), Covered CA is operating under the assumption that it will continue at least until the end of 2017.
Covered CA is the Health Insurance Exchange for our great state of CA. Using this option, an individual may purchase health and dental coverage as well as obtain Advance Premium Tax Credits (APTC) also known as subsidies to help pay the premiums. These subsidies are based on age, income and family size and can be quite substantial. The subsidy is granted under the ACA.
Individuals may also buy health insurance directly from insurance carriers. Anthem Blue Cross and Blue Shield are the primary carriers in our area. These policies are exactly the same as those offered on the Exchange, however there are some additional offerings that have slight variations that are not available on the Exchange. The provider networks are exactly the same whether coverage is purchased on or off the Exchange.
The ACA requires that there be an annual open enrollment period where any individual can apply and be granted coverage regardless of their health history. Once insured, there are no limitations for pre-existing conditions.
The open enrollment period runs from 11/1/2016 to 1/31/2017. Effective dates are based on the application date. Applications received after 1/15/2016 will be effective 3/1/2017.
Absent a qualifying event, MediCAL or Native American Tribal Eligibility, individuals must experience a qualifying event to be eligible to enroll after 1/31. Certain events trigger a Special Enrollment Period (SEP) and include involuntary loss of other qualifying coverage, birth or adoption of a child and marriage.
Many people are feeling uncertain about their options and may think they need not do anything because the ACA is going to be repealed. However, it’s important to note that some of the alternate proposals being discussed include grandfathering those with existing insurance. Essentially, if there is no lapse in coverage, then you would not be subject to pre-existing condition limitations. This could be a good reason to take advantage of open-enrollment and at least get some coverage, even if it is a high deductible plan.
The plans are labeled as bronze, silver, gold and platinum depending on the level of coverage (60, 70, 80 & 90% respectively).
Another pressing issue is income verification authorization. This authorization allows the Exchange to verify income with tax records. It must be current in order to qualify for a subsidy. Further, individuals were required to file their tax returns by April 15th 2016 to secure the tax credits for 2015. Since tax returns for 2016 are not due until 4/18/2017, subsidies are subject to filing by that deadline in 2017.
Covered CA has said that if an individual did not actively renew their coverage, they would “auto-renew” into the same plans in which they are currently enrolled. We have cautioned our clients that it is important to double check your Covered CA account to be sure that enrollment is completed accurately.
In some cases the account continues to show that you must “pick a plan” even though you might have thought it auto enrolled. If you don’t remember your login information, you must contact Covered CA to get a new password. The number is 800-300-1506
It’s not a good idea to start all over. You are better served to review your existing account and confirm that enrollment is accurate.
Note to employers: The IRS has extended the deadline for distribution of individual 1095 C’s to employee to March 2, 2017. That is not great news for employees who want to file their taxes early. They will want to have the 1095C to give to the tax preparer.