Obamacare enrollment, year 2: What you need to know

The second sign-up period for insurance under the federal health law known as Obamacare begins next month. That means state residents who buy their own health plans will be able to shop for private insurance through Access Health CT, the insurance marketplace created by the health law. People can also buy coverage outside the exchange through insurance companies directly, or through brokers and agents.

This year’s enrollment period brings some changes from last year, including a shorter shopping season, different plan options and a higher penalty for those who don’t have insurance in 2015.

Here are some of the key details of what you need to know.

New to Obamacare? Skip to the third section for a primer to get you up to speed.

You can also find more information about Obamacare, insurance and health care in The Mirror’s guide to health care in Connecticut. And, as always, you can send us your questions about Obamacare at alevinbecker@ctmirror.org.

What’s new this year?
When can I buy insurance and what are the deadlines?

You can start to shop for insurance through Access Health CT, Connecticut’s health insurance exchange, on Saturday, Nov. 15.

If you want coverage that starts Jan. 1, you’ll have to buy it by Dec. 15.

If you miss the Dec. 15 deadline, you can still buy coverage, but it won’t take effect until Feb. 1 at the earliest.

The sign-up period runs through Feb. 15. After that, you won’t be able to buy private insurance in 2015 unless you experience a “qualifying event” that affects your coverage (like losing your job, getting divorced or moving to another state). People who get married or have a baby after the deadline can add people to their plans within 60 days of the marriage or birth.

The deadlines only apply to private insurance. People who qualify for Medicaid can sign up at any point in the year.

Related: 6 things to consider when picking your health insurance

What’s the penalty if I don’t buy insurance in 2015?

It will get more expensive to go without insurance next year. Individuals who don’t have coverage — and who don’t qualify for an exemption — will have to pay either 2 percent of their income, or $325, whichever is higher.

For households, the penalty is 2 percent of household income or $325 per adult, plus $162.50 per uninsured child.

Those who are uninsured for part of the year will be charged a fraction of the penalty, proportionate to the number of months they were uninsured. People who are uninsured for fewer than three consecutive months won’t face a penalty.

People subject to a penalty would pay it when they file their taxes for 2015 (in 2016).

Some people are exempt from having to pay a penalty, even if they don’t have coverage. People are not subject to the penalty if they are:

  • Not in this country legally
  • A member of an Indian tribe
  • Incarcerated
  • A member of a religious sect that has objections to health insurance
  • A member of a health care sharing ministry
  • Very poor (those who have too little income to file a tax return. Many people in this category will qualify for Medicaid, which is free in Connecticut.)
  • Someone for whom insurance would be considered too expensive to buy, even with employer contributions and/or federal subsidies
  • Someone uninsured for fewer than three months during a year

That last part means that if you don’t buy your insurance until February, you won’t face a penalty for the portion of the year you were uninsured — as long as you maintain the coverage for the rest of the year.

Can I get dental coverage?

Yes. For the first time this year, people will be able to shop for dental plans through the exchange. The dental plans for adults will be sold separately from health insurance plans. It’s different for children: Pediatric dental care must be covered in all health insurance plans sold through Connecticut’s individual market (both in the exchange and outside it), so children covered by those policies won’t need separate dental insurance.

I bought insurance through the exchange for 2014. Do I have to do anything to keep the coverage?

It depends. The exchange has developed a system for automatically renewing coverage for people who don’t take any action, but only if those people meet certain criteria. (In general, people who would face significantly higher costs in 2015 — such as those who got subsidized coverage this year but won’t qualify for the discount in 2015 — would not be auto-renewed.)

Access Health has determined which customers are eligible to automatically renew their coverage, and is notifying everyone whether they can do it or not. Those who are eligible for automatic renewal can still select a different plan or choose not to buy coverage next year, but if they don’t do anything they will be continued in their current plan.

Those who are not eligible for automatic renewal will have their coverage stopped Dec. 31, unless they go through the sign-up process and pick a plan.

Even if you’re eligible to have your coverage automatically renewed, you might find lower-priced or more suitable options if you shop around and compare the new options. You can do that through the Access Health website starting Nov. 15.

You can read more about how the automatic renewal process works by clicking here.

The options
What will insurance cost next year?

Each person’s price will depend on his or her age, county and the type of plan selected. In addition, people with low or moderate incomes will qualify for discounts on their coverage.

This calculator shows what it would cost you to buy a standard plan through Access Health, the state’s exchange. Other unique plans sold by each carrier through the exchange, and plans sold outside the exchange, are not included here.

Starting Nov. 15, you’ll be able to see how much you’d have to pay for any plan sold through the exchange by using the calculator on Access Health’s website.

What do the plans cover?

Every health plan sold on Connecticut’s individual market, including the exchange, must cover a set of “essential health benefits” that includes mental health, maternity and pediatric dental care, as well as services that have more commonly been covered in the past.

But plans vary widely in both monthly premiums and how much you’d have to pay to get care.

Insurance plans fall into one of four metal-tier categories: bronze, silver, gold and platinum. The labels are based on how much of a member’s medical costs the plan will cover. In general, people with bronze plans have to pay the most toward the cost of their care, and people with platinum plans would pay the least. A standard bronze plan sold through Access Health, for example, has a $5,000 deductible for individuals (or $10,000 for family coverage), meaning that members would have to spend that much on medical care before the plan starts chipping in. The deductible on a standard gold plan is $1,000 for individuals ($2,000 for family coverage), and the standard platinum plan has no deductible, meaning that members won’t have to spend a certain amount on medical care before the plan begins paying.

The tradeoff: Plans that cover more of your medical care tend to have higher monthly premiums. So buying a gold plan will probably cost more up front than buying a bronze plan. But if you require a lot of medical care or medication, you might ultimately save money by paying more in premiums.

Even plans with deductibles are required by Obamacare to cover certain preventive care at no cost to the member.

You can see the details on what the Access Health standard plan options look like by clicking here.

If you already have coverage through the exchange and want to see how the plans will change, click here.

The basics
What’s the exchange and do I have to buy my coverage there?

Connecticut’s exchange, Access Health CT, was created as part of the Affordable Care Act, the law commonly known as Obamacare. It’s essentially a store for buying insurance, and offers plans sold by several  private insurance companies. People who qualify can also sign up for Medicaid through Access Health.

The exchange sells health plans for people who buy coverage on their own (rather than getting it from an employer or Medicare) and for small businesses.

Nobody is required to buy insurance through Access Health. Insurance companies sell additional plans outside the exchange, which people can buy through an insurance agent or broker, or through the company directly. Some plans sold outside the exchange have larger networks of health care providers than those sold in the exchange.

However, many low- and middle-income people who buy their own insurance qualify for discounted coverage as part of Obamacare. People can only get those discounts if they buy a plan through the exchange.

Here are the income limits for receiving financial assistance to help pay for coverage in 2015:

Do you qualify for a subsidy?
Income limits for a tax credit to reduce the cost of insurance premiums
Household size Income limit
1 $46,680
2 $62,920
3 $79,160
4 $95,400
5 $111,640
6 $127,880
7 $144,120
8 $160,360
What if I lose my job or need insurance after the enrollment period ends? Should I sign up now just in case?

It depends why you’d need insurance.

If you lose your job, move to another state or experience another type of change in circumstances that causes you to lose your insurance, you’ll be allowed to sign up even after the Feb. 15 deadline. You’d have 60 days from the change to request a “special enrollment period” and sign up for individual-market coverage.

Similarly, people who get married or have a baby after the open enrollment deadline can add their new family members through a special enrollment period.

On the other hand, if you simply choose not to have insurance to start the year and then get sick after the sign-up period ends, you won’t be allowed to sign up for coverage outside the enrollment period. Similarly, if you lose your coverage because you don’t pay the premium, you won’t qualify to buy insurance until the next open enrollment period at the end of the year.

I have Medicare. Do I have to sign up for a plan through the exchange?

No. The plans sold by Obamacare exchanges are not intended for people who qualify for Medicare.

There’s a separate annual sign-up process for people who have Medicare to select health and prescription drug plans. This year’s sign-up period runs from Oct. 15 to Dec. 7. To sign up for Medicare plans or view your options, click here.

My income is erratic. How do I determine if I qualify for an insurance discount?

Experts advise that people estimate their 2015 income when applying for coverage — and promptly report any income changes to the exchange.

Here’s why that’s important:

The insurance discounts are really tax credits, paid in advance to the insurance company on your behalf. If your income is variable, the exact amount of tax credits you’re entitled to won’t be clear until after the end of 2015. If you received a larger discount than you were entitled to, you’ll have to pay some or all of it back to the federal government. If you were entitled to more than you received, you’ll get money back when you file your taxes (or a credit to offset some or all of what you owe). The more you update your income as it changes, the more accurate your tax credits will be throughout the year, and the less chance there is that you’ll be stuck with a big bill at tax time.

People who receive a tax credit to discount their insurance premiums but end up making more than 400 percent of the poverty level for the year — above the threshold for receiving a tax credit — will have to pay the full amount back. People whose income falls below 400 percent of the poverty level but received too large of a discount will have to repay part of what they received, but the repayment amounts are capped, based on income. At most, a family earning just below the subsidy limit could have to repay $2,500.

If you’re concerned about having to repay some of the money, you can also choose to receive the full tax credit when you file your taxes in 2016, instead of having the money paid to your insurance company. If you do that, you’ll have to pay the full bill for your monthly premiums.

Related: Obamacare worry: Unexpected tax bills for those with discounted insurance

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