Second round of Affordable Care Act enrollment starts Saturday

Gainesville Sun
By Christopher Curry

This year, the penalty rises to 2 percent of income, or $325 per person — whichever is higher. The household cap is $975. Next year, the penalty goes up again to between 2.5 percent of income or a $695-per-person fee for individuals. After that, it continues to rise based on inflation.

The penalty rises over time until it is roughly equal to the amount a person would pay to buy insurance.

Some businesses that do not purchase insurance for their employees also will see penalties for the first time in 2015. Businesses with 100 or more full-time employees will have to offer coverage to at least 70 percent of their workforce or face a penalty in 2015. In 2016, the coverage requirement rises to 95 percent of employees.
Businesses with at least 50 full-time employees and fewer than 100 will not face any penalties until 2016. Businesses with fewer than 50 full-time employees are exempt from the law’s employer mandate to offer coverage.

While enrollment does not start until Nov. 15, HealthCare.gov does allow people to look at coverage options and cost and tax subsidy projections by plugging in their ZIP code, age, income, family size and information such as whether they smoke.

Besides low-premium, catastrophic coverage that covers only very high medical and hospital expenses, there are four “medal” plans from the lower-premium bronze up to the higher monthly premium platinum. Under bronze, insurance covers 60 percent of health care costs with the consumer paying 40 percent. The percentage that insurance covers rises through silver (70 percent), gold (80 percent) and platinum (90) percent.

Vagelakos said the automatic re-enrollment is intended to avoid any gap in coverage. She said people who have coverage now and are automatically re-enrolled because they take no action by Dec. 15 will still have the option of changing plans before the Feb. 15 end of enrollment. But they will then have a new plan and will lose anything they paid toward the deductible under the old plan, Vagelakos said.

She said this enrollment period is also the first opportunity for anyone who purchased coverage last year to change plans. In some cases, someone who opted for a low monthly premium last year but ended up seeing a doctor more than expected may opt for a plan with a higher premium and lower out-of-pocket costs for co-pays and deductibles.

With two new companies now offering plans in Alachua County, Hazy said he expects a lot of people to switch plans and possibly companies. He said one area of concern is how the HealthCare.gov website will handle those changes and if someone who changes companies might end up being erroneously double billed for the premiums of two plans.

For people who do not want to change coverage, Vagelakos recommended they still go on HealthCare.gov and update their personal information, including any changes to their family or income. That will help determine whether they are eligible for a tax subsidy and what level of subsidy they receive, she said.

Another new development this year is the increased penalty for not purchasing insurance.
For individuals who do not purchase coverage and are not exempt for income reasons, the penalty rises this year and continues to increase in the future.

Last year, the penalty for an individual was 1 percent of income above the taxing threshold or a $95 flat fee — whichever is higher. The household cap for a family was $285.

This year, the penalty rises to 2 percent of income, or $325 per person — whichever is higher. The household cap is $975. Next year, the penalty goes up again to between 2.5 percent of income or a $695-per-person fee for individuals. After that, it continues to rise based on inflation.

The penalty rises over time until it is roughly equal to the amount a person would pay to buy insurance.

Some businesses that do not purchase insurance for their employees also will see penalties for the first time in 2015. Businesses with 100 or more full-time employees will have to offer coverage to at least 70 percent of their workforce or face a penalty in 2015. In 2016, the coverage requirement rises to 95 percent of employees.

Businesses with at least 50 full-time employees and fewer than 100 will not face any penalties until 2016. Businesses with fewer than 50 full-time employees are exempt from the law’s employer mandate to offer coverage.

While enrollment does not start until Nov. 15, HealthCare.gov does allow people to look at coverage options and cost and tax subsidy projections by plugging in their ZIP code, age, income, family size and information such as whether they smoke.

Besides low-premium, catastrophic coverage that covers only very high medical and hospital expenses, there are four “medal” plans from the lower-premium bronze up to the higher monthly premium platinum. Under bronze, insurance covers 60 percent of health care costs with the consumer paying 40 percent. The percentage that insurance covers rises through silver (70 percent), gold (80 percent) and platinum (90) percent.

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