Enrollment for the Affordable Care Act's health insurance exchanges' 2016 plans is open from Nov. 1, 2015 to Jan. 31, 2016.
If you miss the Jan. 31, 2016 deadline, you won't be able to buy a health insurance plan for the rest of 2016 unless you have a life change, such as having a baby or getting married.
Individuals and families who qualify will receive subsidies in the form of tax credits to offset costs. (See if your family qualifies for a health insurance subsidy.)
You may also purchase individual or family health insurance plans from insurance companies or through agents; you won't qualify for any subsidy, but you may wind up with a broader set of options for hospital networks and doctors.
So, if you do not have access to health insurance through your employer, need coverage and are ready to enroll, but aren't sure how the process works, don't fret. We will outline the process, starting with the information you'll need to apply. Then we'll explain the application and enrollment process. Finally, we'll outline the four types of plans.
Gather necessary documents before shopping
Ever dealt with Uncle Sam, from filing your federal tax return to signing up for Social Security? Then you have a good idea of the details you'll need for the Health Insurance Marketplace -- the virtual "shopping center" where you'll choose and purchase your insurance coverage. Those details include:
• Name, contact information and Social Security number for you and every member of your household who needs health insurance or is listed on your federal tax return.
• Incarceration status for anyone for whom you're applying.
• Immigration status, document type and number for any member of your household who is an immigrant.
• Active military or veteran status for you or any member of your household.
• Job information about you and every member of your household, including each person's wages and his or her employer's contact information.
• Other income that you or any household members receive in the current month and how often it's paid out, excluding child support, veterans' payments or Supplemental Security Income (SSI).
• Any federal tax deductions you claim.
• Specifics about health insurance anyone in your household has, including coverage type, the name of the covered person, insurance company name, policy number and whether it's COBRA or a retirement plan.
• If anyone in your household has health insurance through a job, that person's employer must provide more information via the "Employer Coverage Tool" (many employers have already provided this information for employees). Transfer the information to your application.
• To choose wisely among the policies you'll be offered, you must know how health insurance works and you should get yourself familiar with terms, such as premiums, copayments, deductibles, out-of-pocket maximums and provider networks.
The application process for health insurance exchanges
The first step in enrolling for a health insurance policy in the marketplace is to determine where to apply. Online, you'll go to Healthcare.gov to find the website for residents of your state. You can also call 1-800-318-2596 seven days a week, 24 hours a day to learn where to apply in person or by phone. In any case, if you don't want to apply yourself, you can authorize someone else to do it.
When you go to your marketplace website, you'll create an account with a user name, password and security questions.
Next is the application. If you apply by phone or in person, your helper will choose the right form. Online, you'll see three options:
1) Health Coverage and Help Paying Costs
2) Short Form
3) No Financial Assistance
Use the first or second form option if you want health insurance and financial help to pay for it. For yourself and family members, use the first form. Singles can also use it, but the "Short Form" is designed for them and will take less time. The third form is for individuals or people with families who either don't want or don't qualify for financial assistance.
Next, use the information you gathered to fill out the application. You can always save your application and come back later to continue working on it. As you type in your information, the system will check your entries against Social Security, IRS and other federal databases. Mismatches with government information will be flagged, and you'll need to explain the discrepancy.
Once you enter all your information, the marketplace will show you health insurance options that fit your needs. Four "metal" plan levels are available: bronze, silver, gold and platinum. At each level, many plans will be available, and all offer the same 10 required services. You'll likely be offered plans in more than one level.
You don't have to figure out your costs, subsidies or credits. The marketplace does all of that for you, based on the information in your application. For a benchmark, though, know that you'll qualify for premium discounts in the form of tax credits if you earn up to 400 percent of the federal poverty level -- that's $97,000 for a family of four in 2015. If you earn up to 250 percent of the federal poverty level, you will be eligible for lower deductibles and copayments as well.
Bronze plans will typically offer the lowest premiums, but they will most likely also have the highest out-of-pocket costs. As you climb the levels, premium costs rise, but out-of-pocket costs drop.
- Bronze - The insurer pays 60 percent; you pay 40 percent.
- Silver - The insurer pays 70 percent; you pay 30 percent.
- Gold - The insurer pays 80 percent; you pay 20 percent.
- Platinum- The insurer pays 90 percent; you pay 10 percent.
A bronze plan's low premiums may seem tempting, but if you expect to visit medical providers frequently, you will pay more out-of-pocket. Therefore, a gold or platinum plan might save you money. If you don't expect frequent visits to medical providers, a bronze or silver plan might be best. Online calculators will help you compare these plan costs. After you evaluate your options and decide how you'll pay the premiums, you'll choose a plan and sign up.
Some of the less expensive plans come with very limited choices of doctors and hospitals you can use for care. So if you have a particular doctor or hospital in mind for your care, you should check the plan to be sure they are listed before you sign up.