Five tips for procrastinators who need to buy health insurance
Thinking about enrolling in an insurance plan under the health law? It’s not too late, but you’d better get moving fast. Open enrollment ends Sunday.
“If you or someone you know needs health insurance, now is the time to act!” Sylvia M. Burwell, secretary of the Department of Health and Human Services, wrote in a blog post Tuesday. “The Open Enrollment deadline is February 15, and there is less than a week left to sign up.”
If you who don’t get coverage at work or are otherwise uninsured, you may qualify for financial assistance for coverage purchased on the exchanges, or marketplaces. You can compare plans and prices at the federal website, healthcare.gov, or, if your state has its own exchange, shop there to find out which coverage is best for you. If your state has expanded Medicaid, the federal-state program for low-income people, you might also qualify for coverage there.
And remember, if you don’t have coverage, you may pay a penalty at tax time.
Among consumers in the 37 states where the federal government is running the exchange, 8 in 10 could pick a plan with monthly premiums of $100 or less after tax credits, according to HHS. Eighty-seven percent of individuals who signed up for coverage through healthcare.gov qualify for financial help, HHS said. This year, 25 percent more insurers are offering plans in the marketplace, giving consumers have an average of 40 plans to choose from, the agency said.
For those of you who have waited until the last minute, here’s a revised version of the Kaiser Health News five things to keep in mind as you shop for coverage:
I don’t have much time. How do I do this?: You’ll need several documents before you start the process, such as Social Security numbers for everyone in your household, employer and income information like pay stubs or W-2 forms and your best estimate of what your household income will be in 2015. Healthcare.gov features a complete list of items you’ll need. Also think about the particular physicians, hospitals and other health care providers you prefer so you can determine if they’re in a health plan’s network before you enroll.
While people can sign up for coverage online or over the phone, “last year we saw that consumers who got in-person help were nearly twice as likely to successfully complete the enrollment process,” said Andrew Dupuy, regional communications director for Enroll America, a nonprofit group that is working to enroll people in the health law. “We think it’s important that consumers know that free, local, in-person assistance is available because it can really help people navigate the process in the final week.” Consumers can schedule an appointment in their community with Enroll America’s Get Covered Connector tool or by attending a local enrollment event.
Do I have to buy health insurance? No but if you don’t you might have to pay a fine. People who skipped coverage last year will have to pay a penalty that is the greater of a flat $95 per adult and $47.50 per child under age 18, up to a maximum of $285 per family, or 1 percent of your family’s modified adjusted gross income over $10,150 for an individual, $13,050 for a head of household and $20,300 for a married couple filing jointly. This year, the penalty increases to $325 per adult or 2 percent of income. The requirement to have health insurance applies to both adults and children, but there are exemptions for certain groups of people and those who are experiencing financial hardship.
Find out if you qualify for financial help: Enter your most up-to-date income information on healthcare.gov or with your state exchange to see if you are entitled to receive a tax credit toward the cost of your health insurance. Even if you received a subsidy in 2014, update your income to make sure you get the correct amount. This is important because if you get too much of a subsidy, you’ll have to repay it when you file your 2015 taxes.
Know all costs: It’s not just the monthly premium that will cost you. Understand a policy’s out-of-pocket costs, things like co-pays, co-insurance and deductibles, before you enroll. The health law allows out-of-pocket maximum caps of $6,600 for an individual policy and $13,200 for a family policy in 2015 but some of your health care expenses – including out-of-network care – might not be included in that cap.The National Health Council, made up of more than 100 health-care organizations, has put together a web site to help consumers that includes a calculator that will estimate differences in costs among health plans.
Get help ff you need it: Confused? There are several ways to get help. Work with a local insurance agent or broker. Find one of the law’s trained navigators or assisters. Or call the federal consumer assistance center at 800-318-2596 for extra help or to find out if you eligible for a subsidy. Folks there can also help you enroll in a health plan or if you qualify, Medicaid. Federal officials have said that they expect the website and consumer phone lines to be busy this week, so be patient. They have bolstered staffing but you may experience some delays. As was the case last year, consumers who have started the enrollment process and are in line to finish their application when the Sunday deadline arrives will be able to complete the process, according to HHS.
For most consumers, if they don’t enroll by the deadline, they’ll have to wait until the next open enrollment unless they qualify for a special enrollment period or an exemption. People can apply for coverage under Medicaid or the Children’s Health Insurance Program at any time during the year.
Kaiser Health News is an editorially independent news service. It is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente.