Saturday marks the start of open enrollment for individual health insurance plans under the federal Affordable Care Act.
Rolled out last year, the individual mandate of the Affordable Care Act brought major changes to insurance coverage in the U.S., creating essential benefits that must be covered and requiring that most Americans have health insurance. As the mandate approaches its second year, a three-month open enrollment period is beginning.
Alaskans use the federal "marketplace" -- Healthcare.gov -- to sign up for insurance plans. Last year, nearly 13,000 Alaskans signed up for health insurance through Healthcare.gov, many during the last month of open enrollment. Most of them were eligible for subsidies that reduced their premium costs.
Planning to enroll or already enrolled? Here's what you need to know.
When is open enrollment?
Open enrollment begins Saturday, Nov. 15, and ends Feb. 15, 2015.
You must apply by Dec. 15 to have coverage effective Jan. 1, 2015.
If you enrolled last year, apply by Dec. 15 to avoid a lapse in service or any risk of losing your subsidy.
Who qualifies for ACA plans?
In order to qualify for a plan under Healthcare.gov, you must live in the U.S. and be a citizen or national or have an eligible immigration status.
If you receive health care through a tribal clinic, you can still sign up for a health care plan.
You are not eligible if you qualify for Medicare or Medicaid. You aren't eligible if you are incarcerated.
I enrolled in a plan last year. Do I need to re-enroll?
That depends. If you have a subsidy, you may need to re-enroll. On last year's forms, you had the option of choosing "yes" to annual income verification. If you checked "yes," you will be re-enrolled automatically. If you checked "no," you will need to re-enroll. Sign up by Dec. 15 to avoid a lapse in coverage.
Both Premera Blue Cross spokesperson Melanie Coon and Moda Health spokesperson Jason Gootee recommended re-enrolling every year if you have a subsidy.
If you don't have a subsidy, you do not need to do anything. You will automatically be re-enrolled in your plan. However, you can switch plans if you like.
Coon said roughly 100 Premera customers received letters notifying them that their ACA plans had been discontinued. They will be automatically enrolled in a similar plan, Coon said. For peace of mind, she suggested logging into your account and checking that you have the coverage you want.
How much do plans cost?
How much you pay can differ depending on the type of plan you select, your age, ZIP code and income. If you are a smoker, your plan may be more expensive.
Two insurance providers, Premera Blue Cross and Moda Health, offer plans on the marketplace. Plans with cheaper monthly rates have higher out-of-pocket costs.
If your household falls within a certain income range, you may qualify for a subsidy, which reduces your monthly costs.
How do subsidies work?
Update, Friday Nov. 14, 2014: Healthcare.gov's subsidy calculator used to browse plans before open enrollment begins is inaccurate for Alaska, according to a Friday release from insurance brokerage firm Enroll Alaska. Subsidies quoted by the calculator are lower than what they will be, and the income eligibility is inaccurate.
You will be eligible for a subsidy if your income is between 100 and 400 percent of the federal poverty level. For an individual in Alaska, that's more than $14,580 and less than $57,400 a year.
For subsidy eligibility for different household sizes, you can look at Alaska's federal poverty guidelines laid out on the FamiliesUSA website. Scroll down to "Alaska" to see what income ranges you must fall within to be eligible for a subsidy.
If you have insurance through your employer, you are eligible for subsidies only if your coverage isn't considered "affordable."
Do plans cost more this year?
Yes. Rate increases were announced in September. Those hit hardest by the increases are people without subsidies, roughly 6,000 Alaskans. If you have a subsidy, the cost increases will vary, and your cost may not change much. Browse the plans to see what this year's rates are.
What is covered under the plans?
Under the Affordable Care Act, all health care plans now provide 10 "essential health benefits," including mental health and substance use disorder services, prescription drugs, emergency services, hospitalization, preventive and wellness services, and maternity and newborn care.
You cannot be turned down for insurance for having a pre-existing condition.
Is dental included in the health care plans?
Pediatric dental care is an essential health benefit, so anyone under the age of 19 with health insurance automatically has dental care, Gootee said. For adults, a separate dental plan must be purchased directly with an insurance company.
Can I sign up through an insurance company directly and not use the marketplace?
Yes. You do not need to sign up through Healthcare.gov. However, you will not be eligible for subsidies if you sign up out of the marketplace. Last year, about 3,000 Alaskans signed up outside of the marketplace.
If you don't qualify for a subsidy, it may be easier to get insurance directly through an insurance company, Coon said. Premera, United Healthcare, Aetna, Moda Health and Assurant Health all offer individual insurance outside of the marketplace.
What happens if I dont have insurance and dont sign up?
If you don't have health insurance coverage in 2015, you will pay a fee of either 2 percent of your income or $325 per adult, whichever is higher.
Are there any exceptions?
There are some exemptions to the penalty. These include:
- Youre a member of a federally recognized tribe or eligible for health care services through a tribal health clinic.
- The lowest-priced health care plan would cost more than 8 percent of your household income, or you dont file a tax return because your income is too low.
- Youre a member of a religious sect with objections to insurance, or a recognized health care sharing ministry.
- Youre incarcerated.
- You qualify for a hardship exemption, such as filing for bankruptcy, homelessness or death of a family member, or you experienced a natural or human-caused disaster, among other conditions.
- Youre uninsured for less than three months in 2015.
Im exempt from the penalty. What do I do?
You must file an application based on the type of exemption.
What happens if I want to enroll but miss the deadline to sign up?
If you miss the deadline, you can apply for 2015 only if you have a "qualifying life event," such as moving to a new state, income changes, marriage or divorce, or having a baby. You can apply under Healthcare.gov's Special Enrollment Period page.
I have insurance through my employer. Do I need to do anything?
No.
However, you can still choose a plan through Healthcare.gov but your employer will likely not pay any part of the premium, and thus it may be more expensive. You may be eligible for subsidies under certain circumstances. Coon suggests checking with your benefits administrator to see if that's the right choice for you.
Is the website working?
Gootee said the website is working better than it did last year but he expects glitches. He suggested applying early to avoid the last-minute rush that was seen last year.
Where do I sign up?
You can sign up on Healthcare.gov; call 800-318-2596 24 hours a day, seven days a week; apply by mail, or get help from someone locally.
Who can help me sign up?
Like last year, trained navigators and certified application counselors can help folks sign up. To find help nearest you, call the United Way Anchorage at 211 (in Anchorage) or 800-478-2221, vice president Sue Brogan said.
Enroll Alaska, an insurance brokerage firm and division of Northrim Bank, is also helping people sign up.
Update: This story has been updated with new information about the Healthcare.gov subsidy calculator and to add information about where to get help signing up.
Correction: In an earlier version of the story, the Federal Poverty Levels for subsidies were based on 2014 data. They have been updated to reflect 2015 FPL.