Most of us have heard about or personally experienced the incredibly difficult rollout of the Federal health insurance program. Last year showed many signs of improvement from the disastrous initial year in 2013. November 1st is when Gwinnett residents can again enroll for new health insurance for January 2016 effective dates. Will the ‘Marketplace’ website be ready for action? Will plans be affordable? Does any of this even apply to me and my family?
There are a lot of misunderstandings among consumers about this whole process. The Marketplace Exchange (Healthcare.gov) is a Federal website where you can go to buy health insurance on your own with only basic help available. The Annual Enrollment Period is November 1st to January 31st for this year. Most people use this service only if they might be eligible for a tax credit to help reduce the normal insurance premiums. If you already have set up an account then you will also need to update your information annually, or select a new plan if you wish to change.
Not everyone needs to experience this involved process. If you do not need or want a tax credit with the paperwork and constant updates that are required, then you can easily enroll with major insurers and bypass the Federal website.
It is a myth that health insurance can only be purchased through the government website now.
You can do it yourself by going to each insurer and shopping for prices. You can also submit your information on the internet for quotes, but beware, your inbox and phone will be flooded with solicitations. Then, there is the option to find a true health insurance broker that represents all of the plans in your area. You can use these brokers annually without fees, to keep your insurance up to date, and to guide you with unbiased information.
A major problem has been understanding what income qualifies or does not need to be counted in the calculation for these tax credits. Most CPA’s (certified personal accountants) have not yet had full training or classes on the new regulations. Special circumstances such as one spouse on Medicare, a child with income, or a disabled dependent with Supplemental Security Income, can make this a very daunting task. Even the advice from the Federal helpline is often very incorrect, much like the tax helpline at the IRS.
Unfortunately, there are many pitfalls after the purchase of your health plan; especially if your plan is paired with a tax credit for lower premiums. Some headaches during the year are: change of address, adding new children or spouses, change of your income and your family income. There are many more situations that can arise with the Federal system. If you do not meet the strict deadline, your plan may be canceled, altered or you may lose your special tax credit.
You may not need to sign up for health insurance because you receive through work, or through a parent or spouse. But if that coverage is lost during the year, you will need help properly documenting that loss of coverage, and then apply outside of the normal enrollment period. There are deadlines, documentation requirements, and rules that must be met. The average consumer typically misses one or more of these tasks. Then you may have to wait until the end of the year to get your insurance restarted. The appeals process for a case like this can be very poorly handled at the Federal level, and could use some reform itself.
If an insured person fails to pay their premiums or falls too far behind, then they will have their insurance canceled. Again, that person likely must wait until the end of the year to restart new coverage.
One of the largest issues causing coverage cancelation is that people are not watching their emails and regular mail for notifications from the Federal Marketplace. If asked to prove income in order to keep a tax credit, and a person does not respond in a timely fashion, their insurance premium will revert to the normal, higher amount. Mailing in this documentation can be a nightmare. Uploading it on the Federal website has eased this process but you must save proof. Often the Federal site loses this information or has strange errors.
Signing up for health insurance for 2016 should be less strenuous than last year. Many of the kinks have been worked out, but beware the pitfalls that come during and after the open enrollment process. Managing and paying attention to your plan are the most difficult to handle on your own.