Open enrollment for individuals started November 1, 2015 and runs through January 31, 2016. As a reminder, individuals must submit their applications by December 15, 2015 to have their selected coverage effective and in-force on January 1, 2016.
Under the ACA (Affordable Care Act, often known as ObamaCare) individuals under age 65 may buy health insurance during this open enrollment period. The insurance company cannot deny coverage regardless of the individual’s health history and there is full coverage even for pre-existing conditions.
Should you choose not to enroll you will be subject to an individual shared responsibility payment or tax penalty. For 2016 the amount is the higher of 2.5% of household income or $695 per adult and $347.50 per child under the age of 18.
It’s important to understand that the coverage must meet minimum essential coverage requirements. This has prevented the insurance companies from offering very skinny plans that have lots of holes in them. It makes it easier to compare plans as well. Plans are now referred to by the metallic level: Platinum (90%) , Gold (80%) , Silver (70%) & Bronze (60%)
There are Advance Premium Tax Credits (APTC) or subsidies available for lower income persons. The thresholds are up to 400% of Federal Poverty level so the limits are higher than one might think. With the lower incomes in the north state, it’s not uncommon to qualify for a large subsidy. A family of four earning up to $95,400 will qualify for a subsidy. Individuals earning less than $46,680 qualify as well. It’s sometimes challenging to predict income for the coming year, so we suggest that you are conservative in your estimates.
The subsidies are reconciled when taxes are filed. It’s better to get money back than to have to pay more. Also, tax returns must be filed no later than April 15, 2017 in order to qualify.
There is some good news on the product front for this year. Blue Shield of CA is offering a new product that includes a much broader network as well as the Blue Card. This means that there should be more providers that will accept the coverage. The prior product was an EPO (Exclusive Provider Organization) product and if you went outside the network for care, you received no coverage. Further, they did not have any of the University of CA medical centers in the network. That is no longer the case. The product is PPO (Preferred Provider Organization) and includes the UC’s. Blue Shield uses the Exclusive PPO network.
The Blue Card allows reciprocity with other Blue Cross or Blue Shield providers in other states. Both Anthem and Blue Shield will now include this benefit. This can be particularly important if you have a serious diagnosis and want to go out of state for treatment, if you have children who are out of state at school, or if you live in border cities like Yreka. We are told Anthem added about 2.25% to the rates to provide this benefit.
What I have seen so far is that Anthem and Blue Shield rates are very close in the Silver and Gold level of benefits. At the Bronze level, Anthem continues to be quite a bit less costly for basic premiums. It’s important for the consumer to review the networks at the carriers’ respective websites. Anthem continues to use the Pathway PPO which is quote narrow.
For those already enrolled under the Exchange, it’s important to go into the Covered CA website and complete your renewal as soon as possible. Some folks have already received letters showing the full premium without subsidy to be due for 1/1/2016. It is my understanding that enrollment must be completed before 11/27/2015 or the individual will need to reapply.
On Monday Covered CA was not accepting any phone calls. If passwords need to be reset or user names, Covered CA must be contacted. An agent cannot reset. The number is 800-500-1506.
