Obamacare Q&A: Signups start next week

Illustration by Mike Licht, NotionsCapital.com

Mike Licht / NotionsCapital.com

Illustration by Mike Licht, NotionsCapital.com

Sunday marks the start of the third open enrollment period for insurance under the federal health law. That means the nearly 170,000 Connecticut residents who buy their own health insurance will have a chance to shop for new plans – and many will need to take action to keep the coverage they have.

Here’s what you need to know.

When is the sign-up period?

The enrollment period for individual-market insurance begins Nov. 1 and runs through Jan. 31.

People who want their coverage to begin Jan. 1 must sign up by Dec. 15. After that, they’ll have until Jan. 15 to sign up for plans that begin Feb. 1. People who sign up between Jan. 16 and Jan. 31 – the final day of the enrollment period – will get coverage beginning March 1.

Enrollment deadlines
For coverage through Access Health CT, the state’s health insurance exchange
If you sign up by… Coverage will start…
Dec. 15 Jan. 1
Jan. 15 Feb. 1
Jan. 31 March 1
Access Health CT

As in the two previous sign-up periods, Connecticut customers will have a choice between plans sold through the state’s health insurance exchange, Access Health CT, and those sold outside the exchange, which people can buy directly from insurance companies or through insurance agents or brokers.

Related:  Six things to consider when picking your health insurance

People who qualify for Medicaid can sign up at any time during the year.

I bought coverage through the exchange this year. Do I have to do anything to keep my plan?

The vast majority of Access Health customers are slated to be auto-renewed into their current plans if they don’t take action before Dec. 15. But because the rates and plan designs are changing in 2016, you might want to check your options.

How will you know if you’re slated to be automatically renewed? The exchange sent notices to customers eligible for the auto renewals during the first week of October, with information on any changes to their plan and the approximate level of discount they qualify for, if any. And all households that purchased private insurance through the exchange were slated to be sent a mailer this week with information on whether they can automatically renew or not.

Access Health officials say customers should log into their accounts to make sure the information the exchange has about them is correct and that their plan is the best fit for them.

What if you’re eligible to be automatically renewed but don’t want to keep your plan? You’ll have to make changes to your account by Dec. 15 if you want them to take effect by Jan. 1. Otherwise, you’ll be re-enrolled in your current plan starting Jan. 1, and any changes you make will take effect Feb. 1 at the earliest.

Related: The Mirror’s Guide to health care in Connecticut

I usually shop based on price. Is that the best strategy?

Experts say you’re not alone: Individual-market insurance purchases are often driven by price. But experts also warn that it’s important to consider not just the monthly premium, but what it will cost when you get care. Often, the cheapest plans require members to pay thousands of dollars toward their care before the plan begins paying – meaning that by paying a lower premium, you could end up with much bigger medical bills.

For example: The cheapest plans available to most Access Health customers are referred to as bronze plans. But the standard bronze plans have a $5,500 deductible for individual coverage and an $11,000 deductible for family coverage. That means that if you need medical care, you’d have to pay up to your deductible amount before the plan begins chipping in. (The exception is for certain types of preventive care, which all plans must cover at no charge to members.)

By contrast, gold plans have higher premiums, but require members to pay significantly less toward their own care. (The standard gold plan comes with a $1,000 deductible for individuals and a $2,000 deductible for families, and the plan will cover many services even if you haven’t yet met the deductible.)

Related: Shopping for insurance? Be sure to know these terms

Access Health expects to introduce a shopping tool in November meant to help customers get a better sense of the full cost of each plan option, taking into account both the premium and the costs for getting care. It was developed in response to concerns that many customers picked bronze plans and then avoided medical care because of their high deductibles, or otherwise paid more than they would have had they picked a plan with higher premiums but lower care-related costs.

While the exchange’s tool can help people see the approximate cost differences of each plan, Access Health can’t recommend specific plans to individual customers. But insurance agents and brokers can.

Related: In insurance, premium isn’t the full price. Can a tool help shoppers?

What happens if I don’t have insurance?

The penalty for not having coverage is rising in 2016. People who are uninsured, and who aren’t exempt from the coverage mandate, will have to pay either 2.5 percent of their household income or $695 per person in the household ($347.50 for those under 18) – whichever is higher.

While the federal health law requires nearly all U.S. residents to have coverage, some people won’t face a penalty if they remain uninsured. Those include people whose income is below the level that would require them to file a tax return, or people for whom no plan was available that would have cost less than 8.05 percent of household income. You can find more information on exemptions here. To apply for an exemption, click here.

How will the government know if I have insurance?

You’ll have to report whether you had coverage when you file your taxes in 2016.

This year, the Internal Revenue Service left it to people to report whether they had coverage, without requiring backup documentation. This year, taxpayers won’t have to provide any additional information, but their coverage source – meaning their insurer, employer, Medicare, Medicaid or the exchange – will send the IRS proof that the person had coverage.

Have questions about Obamacare? Email Mirror Health Reporter Arielle Levin Becker at alevinbecker@ctmirror.org.

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