1000 x 90

Open Enrollment for Subsidized Health Insurance Begins Nov. 15, See 2015 Marketplace ‘Need-to-Know’ List

By Jesse Wood

Nov. 12, 2014. Open enrollment for the Health Insurance Marketplace begins on Nov. 15 and ends Feb. 15, but if you want coverage to begin by the first of the year, you must apply by Dec. 15.

This is the timeframe that people can apply through the marketplace and receive – if eligible – subsidized health insurance plans.

Eric Schneider, an outreach and eligibility specialist with High Country Community Health, encourages people without insurance or those with questions about coverage for 2015 to be proactive and not wait until the last minute to apply.

“I want people to start preparing now because last year people were coming to us [for assistance near the end of the enrollment period] with questions we just couldn’t answer,” Schneider said, referring to questions regarding income projections and personal tax filing situations pertaining to divorce, new dependents and so forth.

For those that did enroll last year, Schneider said that depending on how you answered a particular question – whether or not you consented to a reassessment of marketplace coverage – during previous enrollment you may have to undergo a renewal process for continued insurance coverage.

Schneider said that those applicants that consented to a reassessment will receive a notice in the mail sometime in early November. Knowing that some folks may not remember how they answered that question, Schneider added that he would rather be in the “safe rather than sorry mode” by having people be vigilant and double check their status either through their online account, a health insurance marketplace navigator such as Schneider or through the marketplace hotline telephone number.

In addition to Blue Cross Blue Shield plans available on the marketplace like last year, enrollees will have more options this year with Coventry Health Care and United Health Care. If nothing else, Schneider said the addition of two more providers will help “control costs.”

Book Appointments with HCCHfor Assistance

While enrollment opens on Nov. 15, Schneider mentioned that navigators at High Country Community Health are already completely book through the first week of open enrollment. In light of that, Schneider said people seeking assistance may want to “call a little bit in advance” to schedule an appointment.

Consumers can begin booking appointments with Schneider now and starting in November. Reach Schneider at erichcch@gmail.com or call 828-773-7297. His office is located at 108 Doctors Drive in Boone. For more information about High Country Community Health, click here.

You may also book appointments with HCCH volunteer certified application counselors at the Harrill Senior Center (Project on Aging) at 828-265-8090 and the Watauga County Public Library at 828-264-8784 ext. 2.

For more information about the Health Insurance Marketplace, click to https://www.healthcare.gov.

Assistance Sessions at Public Library

General info sessions with Q & A:

  • Wednesday, Nov. 19, noon to 1:30 p.m., Watauga Public Library
  • Tuesday, Dec. 9, 5 p.m. to 7 p.m., Watauga Public Library

How to Use Your Coverage

  • Tuesday, Dec. 16, noon to 1:30 p.m., Watauga Public Library
  • Tuesday, Dec. 16, 5:30 p.m. to 6:30 p.m., Watauga Public Library

Below is a “need-to-know” list compiled by Schneider for those looking to enroll or re-enroll in the health insurance marketplace:

Need to know list for open enrollment 2015

– Open enrollment will run from Nov. 15, 2014 – Feb. 15, 2015. This is the time that anyone can apply on the Health Insurance Marketplace to see if they get financial assistance toward purchasing subsidized health insurance plans available on the Marketplace

– The subsidy comes in the form of ‘premium tax credits’ that can be used in advance to make the monthly cost of private health insurance more affordable. The tax credit does not count as income.

– To qualify for these tax credits, you must apply through the Health Insurance Marketplace. Members of a household that don’t have access to ‘adequate and affordable’ insurance through sources such as Medicaid, Medicare, NC Health Choice, VA benefits, or employer sponsored insurance will be likely to qualify for subsidies if their projected household incomes are between 100-400 percent of the 2014 federal poverty level

– Those that go without some form of adequate health coverage in 2015 will be subject to a tax penalty when filing their taxes unless they qualify for an exemption from the tax penalty. The amount for 2015 will be the greater number of either $325 per uninsured adult (half that for children) or 2 percent of household income minus the tax filing threshold. For those that went without coverage in 2014 and were not automatically exempt, some may be able to still file the correct paperwork before they file their taxes and some exemptions can be claimed directly on their 2014 tax forms. The rest will be assessed the appropriate penalty.

– There are also a few barriers to receiving assistance. Due to the state’s decision to not expand Medicaid for all groups below 138 percent FPL, those whose projected incomes fall below 100% will be unable to receive tax credits under the Affordable Care Act. There is also another coverage gap referred to as the “family glitch” that may negate tax credit eligibility for family members that technically have access to being placed on a family members’ employer-sponsored health coverage – even if it is unaffordable by practical standards.

– Most applicants that applied through healthcare.gov last year only had access to BCBS plans through the Marketplace. This year, they will have options with BCBS, Coventry, and United Healthcare.

– For those that already have a Marketplace plan, renewal will be on the table this year. Those in this category should be getting a notice in the mail by early November and, depending on how they answered the renewal question on their Marketplace applications, this notice will detail the processes for renewal. Since this will coincide with open enrollment, households can decide to go back into the Marketplace and reapply based on their 2015 projections to enroll in a new plan or renew their old plans. If current Marketplace policy holders don’t take action by Dec. 15, depending on how they answered questions on their previous application they will fall into one of the following situations:

  1. They will be kept on the same plan with the same tax credit;
  2. If their plan no longer exists for 2015, they will be moved over to the most similar plan with the same tax credit;
  3. They will be reenrolled in a plan without a tax credit.

– If anyone who is currently enrolled in Marketplace coverage and doesn’t receive a letter detailing information about renewal, we encourage them to be proactive and either look over their options on the Marketplace before Dec. 15 or seek out assistance with the process.

– We have come to expect technical issues with this process, but so many people stand to benefit and we don’t want them assuming they will be priced out of coverage without finding out the facts