“Extension on the Go” podcast by Debbie Johnson. Episode 158a: ACA in 2016
COLUMBIA, Mo. – Open enrollment for buying coverage through the Affordable Care Act’s health insurance marketplace ended Jan. 31. That means you can’t buy health insurance for 2016 through the marketplace unless you qualify for a special enrollment.
Due to concerns about potential abuse of these special enrollments, new guidelines have been issued clarifying the enforcement of special enrollment periods.
“The intent of these special enrollment periods is to help those who lose coverage or experience a significant change after open enrollment ends. They are not meant to be an option for the majority of consumers,” said Graham McCaulley, assistant professor of personal finance for University of Missouri Extension.
“If you choose not to get insurance and then you get sick partway through the year, you can’t just pick a special enrollment to get insurance,” McCaulley said. “It’s not a loophole.”
Whether you get health insurance through the ACA marketplace, an insurance broker or an employer, having insurance is still mandatory.
“If you don’t have insurance for more than two months this year, the penalty is 2 1/2 percent of your household income, above the filing threshold, or a flat fee of $695 per adult and $347.50 per child, whichever is greater,” McCaulley said. That flat fee, if it’s the greater of the two, will max out at $2,085 per family.
You can qualify for an exemption and avoid the penalty if the lowest-cost plan available to you through the marketplace or your job costs more than 8.05 percent of your household income, he said. You also can claim an exemption based on recognized religious objections, or for hardships such as incarceration, homelessness, natural disaster and many others.
The ACA penalties are higher this year than they were for 2015. There was also a major change last year that affected many who have insurance through their employer.
“Congress passed legislation that removed the requirement that any large employer, meaning one with more than 200 employees, automatically enroll their employees into a health care program,” McCaulley said.
You can’t take it for granted that you automatically have health insurance from your employer, he said. It’s important to pay attention to any communication from your employer.
During the 2016 enrollment period, 12.7 million Americans signed up through the ACA marketplace, including 290,000 Missourians.
“About eight in 10 qualified for a premium tax credit that averaged about $300 a month,” McCaulley said.
More information is available from MU Extension’s Health Insurance Education Initiative at extension.missouri.edu/insure.