October 31, 2014

Update on ACA Open Enrollment

Affordable Care Act Open Enrollment Period - Update

Washington DC UpdateAs noted in earlier updates, the next open enrollment period for people to sign up for health insurance under the Affordable Care Act (ACA) begins this coming November 15 and ends on February 15, 2015. It is important for consumers to understand that they must enroll and pay their premiums by December 15, 2014, in order to have coverage beginning January 1, 2015, regardless of when they purchased their plan in 2014. (All 2014 plans expire on December 31.) 

As explained in the October 22 Washington Update, some people who purchased health insurance through the federal Marketplace (www.healthcare.gov) in 2014 will be automatically re-enrolled in the same plan, unless they take action. If last year’s plan is no longer available, they will be automatically enrolled in a similar plan. This blog post from the Commonwealth Fund explains how the federal re-enrollment process will work, including how “similar” plans will be selected for those automatically re-enrolled in a plan when the plan they had last year is not available. State exchanges will set their own policies about re-enrollment.

If people are automatically re-enrolled it is still very important that they check out the particulars of their plan, since even the same plan may have been changed in critical elements, such as premiums, cost-sharing, provider networks and benefits. It is also important that they check the subsidy they are expected to receive, even if they receive a notice from the Marketplace indicating that they are automatically getting a subsidy based on last year’s information. In some cases, the subsidy amount will change – even if family size and income and the plan’s premiums remained the same – because the benchmark on which subsidies are based may have changed. See this article from the New York Times.

It is also important that people report any changes in their household size, income, or other factors that may affect their subsidies, so they are receiving what they deserve and not more. In general, anyone who receives an overpayment of subsidies will have to pay that back, up to a cap based on their income, although an exception will be made for individuals in families with incomes that fell below the poverty level. (Due to a glitch in the health care law, people with incomes below 100 percent of the federal poverty level are not eligible for subsidies.)  See this article from Kaiser Health News.

Unfortunately, nearly 90 percent of those who are uninsured are unaware of the November 15 beginning of the open enrollment period, according to a recent poll conducted by the Kaiser Family Foundation.