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When am I required to have health insurance?

A brief overview...
  • The individual mandate of the ACA requires health insurance coverage
  • Residents must have health insurance at all times
  • Health insurance policies take effect in January of each year
  • Residents not exempt from the mandate must have insurance on January 1 of each year
  • Residents that are not exempt must keep insurance from the first day of January for twelve consecutive months

The Affordable Care Act requires continuous, ongoing coverage for everyone not exempted from the law. The rules operate on a calendar year basis; everyone should have coverage from the first day of the year.

Open enrollment runs through the month of January, and the rules require coverage from January through December.

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The Individual Mandate

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The key provision of the Affordable Care Act imposes a penalty on those who fail or refuse to get and keep health insurance coverage.

The individual shared responsibility payment imposed by the Internal Revenue service on the basis of 1/12th of the total due for each month without qualified insurance.

The penalty is the greater of 2.5 percent of family income or fees up to a total of $2,085.00 as described in the below-itemized terms.

  • 2016 penalty for each uncovered adult is $695.00
  • 2016 penalty for each uncovered child or minor is $347.50
  • The penalty is the greater of (1) or (2)
  • (1)2016 adult and child fees up to $2,085.00; or
  • (2) 2.5 percent of annual household income

Open Enrollment Period

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The open enrollment period runs from November through the following January. Subscribers that sign up before the end of December can have coverage as of the first day of January. Those that sign up during January will get coverage within a few days.

The best solution is to have coverage from the first day of the year.

This satisfies the mandate and removes the possibility of a penalty for not having insurance. The open enrollment for the calendar year 2017 is November 1, 2016, through January 31, 2017.

Extensions

The federal government and the states that run exchanges can authorize extensions of open enrollment. The website at healthcare.gov and the state exchanges can announce extensions at any time.

In the past, the governments have used extensions to help applicants finish incomplete applications and to compensate for systems or events that interfered with registration.

For example, states may extend open enrollment when floods, natural disasters, or storms interfere. Extensions help when computer systems cannot handle the volume and applicants experience long online waiting times.

Special Enrollment Periods

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The rules permit a new opportunity to buy insurance when a subscriber has a change in status. These changes involve factors beyond the control of the subscriber such as moving to a different state or area not served by the existing health policy.
Life events include the below-described changes in status.

  • Divorce
  • Marriage
  • Birth of a Child
  • Adoption of a child
  • The 26th birthday of a dependent on a parent’s policy
  • Change of location or address

Qualified Health Insurance

Health insurance policies must provide essential health benefits. These include mental health services, examinations, tests, laboratory work, and screenings at no extra costs. These vital activities support the wellness and prevention goals of the Affordable Care Act.

Medicare, Medicaid, and the CHIP

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Medicare, Medicaid, and the CHIP are among the best options after the open enrollment period ends. These options do not close with the Obamacare open enrollment end dates. Persons who fail to enroll during the open enrollment period may qualify for one or more of these options.

You can get information through  the federal website or the state exchange in the state of residence. Medicaid and the CHIP have income limits and are needs-based programs.

The CHIP is Health Insurance

The Children’s Health Insurance Program meets the requirements of the Affordable Care Act. It is qualified health insurance that provides the essential health benefits. The program serves children and minors in need of medical coverage. It provides health and dental services without regard to ability to pay.

Medicaid is Qualified Health Insurance

Medicaid provides health coverage for persons at or near the federal poverty line. Where Medicaid has expanded, it provides benefits for those above the poverty line and below the income needed for Obamacare policies.

Medicare meets the individual mandate and those with Medicaid will not pay the individual shared responsibility payment. Medicaid can help after a gap in insurance.

Medicare is Health Insurance Coverage

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Medicare meets the requirements of the individual mandate for continuous health insurance coverage. It offers the essential health benefits for affordable, qualified health insurance. Medicare C includes a wide range of Medicare Advantage plans. These cover services and prescription savings.

Comparison shopping is an excellent method for exploring the strengths of these plans and picking the best fit for one’s needs.

Selecting During Open Enrollment

The open enrollment period provides the best opportunity to get covered. The federal and state governments offer assistance, and one can search within and outside of the marketplace to find qualified plans.

Comparison shopping is a proven tool for assessing the features of health plans with the greatest importance to the consumer’s needs or preferences. The ACA groups plans by percentage of insurance-paid benefits.

Comparison shopping permits assessments by factors most important to the consumer’s situation. Using comparison shopping, one can group plans that have a particular feature such as a type of facility or that offer favorable hours of services.

Selecting during Extensions

Extensions are frequently very short periods. Sometimes a matter of days or hours to complete an application. In a short time-frame, it is important to get to the parts of the plans that matter most to the consumer.

Comparison shopping is a quick way to contrast differences in the critical items. One can focus on particular elements such frequently used network services.

Selecting during Special Enrollment Periods

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Using a comparison shopping method, the 60-day special enrollment period is a great time to survey plans outside of the state exchanges or federal marketplace.

Particularly important for upper incomes, many plans outside the Obamacare marketplaces meet the requirements of the Affordable Care Act.

These plans may offer advantages over those listed on the Obamacare systems. Comparison shopping helps when assessing plans with a variety of terms and values.

Getting Maximum Benefit from Coverage

Obamacare runs from January to December; it begins again in January. Unless exempt, citizens and legal residents must always have qualified health insurance coverage. Since everyone must have insurance, the terms should meet the family or individual needs.

Health care goals and preferences will evolve over time and change with events. Comparison shopping is a flexible tool for finding the best value. Comparison shopping focuses on the vital areas of costs, benefits, and coverage.

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