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Can You Enroll In Obamacare Right Now?

Just because open-enrollment has been completed, it does not necessarily mean that you do not still have enrollment options regarding an Obamacare plan. If you have a qualifying life event, meaning you lost your job, moved to a new state or even a new county, had a baby, got married, got divorced, and a number of other “life events”, you qualify to enroll in an Obamacare plan. If that doesn’t apply to you, don’t worry, you still might have other options available to you. We have a list of other qualifying life events listed below. 

During open enrollment each year, everyone who needs new Obamacare insurance or needs to renew their current Obamacare plan can do so automatically. Outside of open enrollment, however, you may only apply for an Obamacare plan if you have a “life event”. If you do not have a life event, you will have to wait until open enrollment starts again to get an Obamacare plan.

If you need health coverage right away though, you should consider a short term plan to hold you over until the next open enrollment period starts.  Short term plans can start next day and are oftentimes half the cost of an Obamacare plan (without subsidies) so these are affordable alternatives for many families.

For 2018 policy year, open enrollment ran from November 1, 2017 to December 15, 2017. 

The next open enrollment period starts on November 1, 2018 and ends on December 15, 2018. 


What is a “life event?”

The Affordable Care Act states you can enroll anytime during the year if you experienced a “life event.” These include:

  1. Marriage
  2. Birth, adoption, or placement of a child in your household
  3. Permanent relocation to an area offering different plan options
  4. Change in income or household status that affects tax subsidy eligibility or cost-sharing reductions of your qualified health insurance plan
  5. Loss of other health coverage
    Examples include job loss, divorce, loss of Medicaid or CHIP eligibility, expiration of COBRA coverage, a health plan becoming decertified.

You can enroll only within 60 days from the date of your qualifying “life event.” If you believe you qualify, start by applying above and then call to have an agent assist you through the process or you can consider short term insurance until Open Enrollment restarts on November 1, 2018.


I don’t have a “life event” so what are my options today?

If you don’t qualify for a life event and you need insurance right now, you can enroll in “short-term insurance.” These are temporary health insurance plans designed for people without health insurance or can’t afford the rates of major medical coverage. Generally, rates are far cheaper than Obamacare, however you can only have short-term insurance for a short period of time and you’ll have to disclose any medical conditions, which may increase your rate or disqualify you for coverage, unlike with Obamacare. Also, since it’s not considered minimum essential coverage under the Affordable Care Act (ACA), you’ll have to pay a tax penalty at the end of the year. You can view short term plans here.


Additional Facts And Information on Obamacare

Patient Benefits and Protections

Insurance companies used to be able to discriminate based on gender and pre-existing condition. Under the ACA, insurers can no longer deny coverage to people with a pre-existing condition or charge higher fees to women for receiving the same services as men. When you apply for health insurance now, you’ll be accepted for coverage regardless of your demographic or health needs. There are other built-in benefits to the new healthcare law. In an effort to make sure that people get the right coverage, the ACA requires all new health insurance plans created after March 23, 2010 to cover “ten essential benefits.” These benefits are:

  • Emergency care
  • Hospitalization
  • Lab testing
  • Maternity care before, during and after labor
  • Mental health counseling services
  • Outpatient or ambulatory care
  • Pediatric services
  • Prescription drugs
  • Preventative services
  • Rehabilitative care and related equipment

You may not need all of these benefits during your lifetime, but you have the option under the ACA to take advantage of these services without worrying about whether your insurance provider will accept the claim or not. Plus, you’ll gain access to preventative care that can help doctors catch and treat problems before they become serious.

Not only do you gain the benefit of routine care and affordable options, but you’ll also be better protected under the new law when it comes to dropped coverage. Insurance companies can no longer drop you from their policies for arbitrary reasons. Also, your insurer has to spend at least 80 percent of collected premiums on healthcare. The new law holds insurance companies accountable for their spending and policymaking.


Obamacare And The Tax Penalty (Updated For 2019)

The “individual mandate” provision of the ACA requires that all eligible American citizens must have qualifying health insurance coverage that complies with the ACA. Currently, it looks that at least on a federal level, the tax penalty for not having Obamacare or ACA compliant coverage is going away. That said, on a state level, there may be some cases where a state will impose a tax or fine if someone doesn’t have qualifying coverage. 

What happens if you don’t apply for health insurance if you’re eligible? The biggest problem, is that you don’t gain access to any of the great benefits afforded by the ACA, or the financial safety net that it provides.

Not everyone will be taxed a fee if they don’t have insurance. Members of certain religious groups and Native American tribes, for instance, don’t have to buy insurance or pay the fine. The HealthCare.gov website offers a complete list of the acceptable exemptions to the individual mandate.

Additionally, in December 2017, Congress passed a tax bill that included a revision revoking the individual mandate starting in 2019, which means that unless the law is changed again, no one will be penalized for not having Obamacare coverage starting in 2019. Unless, your state imposes a fine of their own. 


Applications on the Marketplace

The ACA created marketplaces to facilitate insurance applications. These marketplaces, also referred to as health insurance exchange sites, operate like virtual shopping centers in which you can browse through plans before you even submit an application.

You’ll also use the marketplace to apply for subsidies, which are advance premium tax credits issued by the government to lower the cost of your health insurance premiums. Subsidies are available to people whose income falls between 100 and 400 percent of the federal poverty limit.

If you use the marketplace to apply for health insurance, then you’ll need to take note of the annual open enrollment period each year to make sure you submit an application in time. For 2018, open enrollment runs from November 1, 2017 to December 15, 2017. After December 15th, consumers won’t be able to sign up for health insurance or receive federal subsidies unless they qualify for a special enrollment period by having a qualifying life event.

Open-Enrollment For the 2018-2019 Season (coverage for 2019) Starts On November 1st, 2018 and Runs Through December 15th, 2018. 


Why is health insurance required now?

The ACA works on the premise that those who apply for insurance will contribute to a system that makes healthcare more affordable for everyone else. If you don’t submit an application and sign up for insurance, then you’re operating outside of the system. In other words, you’re not paying your “fair share” or “shared responsibility” payment required by the new law. This becomes a problem when someone seeks medical care but can’t pay the bill. Costs go up nationwide, and we end up where we started with a faulty healthcare system.

To offset these costs, the government has instituted a fee schedule for people who choose not to apply for health insurance. Here’s how it works:

  • When you go to file your taxes in April, you’ll be asked whether you purchased a health insurance plan. The IRS will be able to check this against records from your employer, a private company or the marketplace.
  • If you didn’t buy health insurance, then you’ll be charged a flat fee or percentage based on your income.
  • In 2017 the fee was the greater of $695 or 2.5 percent of your income per individual. There are additional fees for each member of your family and any children who live with you.


The Filing Threshold

We should also point out that the penalty fee only applies to your taxable income, which means the amount that the government counts toward your taxes. This is referred to as your “filing threshold.” For an individual, the filing threshold is about $10,150. Any amount you make above the filing threshold will be taxed and assessed for the penalty fee.

  • For example, let’s say you earn $28,000 per year with no dependents or spouse.
  • Your taxable income is around $18,000 after you subtract the $10,150 filing threshold.
  • If you calculate 1 percent of that taxable income, you get $180. Since that amount is greater than $95, you’ll pay the $180 when you file your taxes.

The IRS can’t impose any criminal sanctions against you for not paying your shared responsibility fee, but it can deduct your payment from any refund that you might have gotten. Plus, they can add interest every year until you pay it, which could add up over time. It’s much better in the long run to apply for health insurance and get the care that you need than it is to keep paying a shared responsibility payment.