ACA Open Enrollment Closing Soon

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people are feeling uncertain about their options and may think they need not do anything because the ACA is going to be repealed.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.

Margaret R. Beck
Margaret Beck  CLU, ChFC, CEBS started her insurance practice in Redding in 1978. As an insurance broker/consultant,  she represents businesses and individuals as their advocate.  She assists in choosing proper products, compliance with complex benefit laws and claims issues once coverage is placed. All information in her column is provided to the best of her knowledge, subject to final regulation by the respective agencies. Questions to be answered in this column can be submitted to Beck's column is also published in the Redding Record Searchlight.
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4 Responses

  1. Joanne Lobeski Snyder says:

    Thanks for this article Margaret.

    I am dismayed by the barrier giant corporations have installed between themselves and customers.

    I signed up for ACA Blue Cross last year. Before the open enrollment, Blue Cross changed my insurance from a PPO to a EPO without my knowledge or permission.  I then signed up for ACA Blue Shield and was enrolled in both until I asked for help from an outreach and enrollment specialist at the Shasta Community Health Center to get me un-enrolled with Blue Cross, because, after being shunted from person and  person all over the world, I was faced with a 40 minute wait to talk to yet another person.

    I look forward to reading your articles to help me make sense of this whole world of insurance.



  2. Beverly Stafford says:

    “The open enrollment period runs from 11/1/2016 to 1/31/2017. Effective dates are based on the application date. If the application is submitted before 1/15/2017, coverage will be effective 2/1/2017. If after 1/15, the coverage is effective 2/1/2017.”   Wouldn’t the effective date after 1/15 be either 2/15/2017 or 3/1/2017 rather than 2/1/2017?

    • Beverly, once again your keen observation noticed the error. hhank you!

      Margaret tried to reply to you, but for some reason it went to spam.

      That paragraph is now corrected, thanks to you. Gotta love online revisions.

  3. Gary Tull says:

    Clearly, health care coverage for profit does not work for everyone. Ultimately the only practical answer is Medicare for all – a single payer system.


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