Monday, May 5, 2014

Demystifying Obamacare if you didn't sign up - By Peter Hanson

Open enrollment for 2014 Affordable Care Act Plans, AKA – Obama Care, has officially ended and is due to resume on November 15th of this year. There are, however always exceptions. Someone can enroll into a Qualified Health Plan if they have what’s called a Qualifying Life Event such as: Marriage, having a baby, adopting a child or placing a child for adoption or foster care, moving outside your insurer’s coverage area, losing other health coverage – due to losing job-based coverage, divorce, the end of a policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP, and similar circumstances , gaining citizenship, leaving incarceration, Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year. 

Important: Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as “minimum essential coverage”. So what is minimum essential coverage? Minimum essential coverage is the type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage.
It’s important to know that if you do have a health plan that does not meet the minimum essential coverage or no coverage at all you will be assessed a fine of $95 or 1.5 percent of your adjusted gross income (line 38 on your taxes), whichever is higher. This dollar amount and percent increases next year and again in 2016.

Many folks that have missed the deadline for enrollment have found some peace by still purchasing health coverage that doesn’t meet the mandates set forth by congress and, yes, they still have to pay a fine. They are purchasing short term policies offered by a few insurance carriers and are available right here in Maine. The applicants must qualify for these plans that are designed to cover and carry them up to the next open enrollment period.

These folks with the short-term plans sleep well at night because they know what they’re not going to have to pay for, such as: The cost of the hospital stay and other medical fees associated with an unexpected heart attack, or diagnosis of cancer and the following treatment. These people are purchasing these plans to cover the costs associated with the unanticipated accident which results in three months loss of income because they can’t work.

No question about it, there is a lot to know about insurance and the Affordable Care Act. It’s difficult to navigate the new laws and available plans alone. Seek the advice and guidance of a licensed insurance agent – It’s what they do.

Peter Hanson works at Maine Insurance Benefits Group in Windham.

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