With open enrollment quickly approaching, we wanted to list and explain some of the more important dates on this year’s schedule for your convenience and to supplement your knowledge. Before we get to the dates for standard enrollees, however, we should mention a few dates related to Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and job-based health insurance.
Open Enrollment Exceptions and Deviations
For individuals and families who are looking to apply for Medicaid or the Children’s Health Insurance Program, there is no enrollment period, but your clients should first check to see if they qualify before submitting an application.
Open enrollment for Medicare begins on October 15, and job-based health insurance open enrollment dates are established by employers – who usually set this period in the fall, with coverage beginning on January 1.
Lastly, those seeking to obtain travel insurance are usually restricted in their ability to purchase coverage to the time immediately after making their arrangements.
Additionally, most insurance sources have exceptions that will allow your clients to enroll outside of open enrollment in special circumstances, usually referred to as “qualifying life events.” These exceptions constitute what is traditionally known as a “special enrollment period,” which allows your clients to apply for or change their health insurance if their circumstances have altered due to:
- Occupational changes
- Geographical changes
- Marital status changes (divorced, married, or widowed)
- Aging off of their parents’ plan (26 years of age)
- COBRA insurance expiration
- A new child
Please bear in mind that your clients are not eligible to participate in special enrollment if they lose their previous coverage due to lack of payment. Further, your clients have only 60 days following one of these life events to apply for special enrollment.
Significant Open Enrollment Dates in 2016 and 2017
For those who are not eligible for any of the exceptions noted previously, the following open enrollment dates apply:
- November 1, 2016: Open enrollment begins, allowing clients to enroll, re-enroll, or alter a current plan through the Health Insurance Marketplace. The earliest that coverage can begin is January 1, 2017.
- December 15-17, 2016: The last days to enroll in or alter a plan with coverage set to begin on January 1, 2017. Healthcare.gov has granted a 48-hour extension to this deadline, but if your client misses this it, their coverage cannot begin until February 1.
- January 1, 2017: Coverage begins for all those who enrolled by December 15, 2016.
- January 15, 2017: The last day to enroll in or change a health plan for coverage beginning February 1. If your client misses this deadline, their coverage cannot begin until March 1.
- January 31, 2017: The final day to enroll in or change a health plan for 2017, after which, only those who are eligible for special enrollment may acquire or alter their coverage. More specifically, if your uninsured client misses this deadline, they will not be eligible to receive coverage without meeting the qualification(s) for special enrollment.
The Individual Mandate
If your client meets the income requirement in accordance with their financial circumstance to purchase health insurance and misses the final deadline for open enrollment, they will be subject to a sizable tax penalty known as the Individual Mandate fee. This is a recurring fee for each month that they, their spouse, and/or their dependents do not have “minimum essential coverage.” This fee becomes due when they file tax returns for the year in which they and/or their family members lacked coverage and is calculated in one of two ways:
- Per Income
- 2.5% of household income
- The maximum amount is the totally yearly premium for the national average price of a Bronze plan sold through the Health Exchange
- Per Person
- $347.50/child under 18
- The maximum amount is $2,085
In order to pay the fee using the percentage method, your client must only include the portion of their household income that exceeds the annual tax filing threshold. For the per person method, your client will only pay for their family members and dependents who did not have coverage. For clients who were covered during at least part of the tax year, the fee is 1/12 of the annual amount for each month that they or their family members lacked coverage. However, if they or their family members go without coverage for less than two consecutive months, they are not subject to the fee – known as the “short gap” exception.
The Canopy Health Network
Please continue to follow our blog for up-to-date and in-depth information regarding open enrollment, the Affordable Care Act, and the healthcare industry. We will also be detailing upcoming Canopy events, news about our affiliate facilities and physicians, and our ever-expanding service area.