5 Things to Know About Open Enrollment

If you or your family is in need of health insurance for 2018, enrollment for a plan under the Affordable Care Act, also referred to as Obamacare, will open Nov. 1. After Dec. 15, the annual enrollment window will close and you will not be able to access insurance until the following year.

With that in mind, here are five important things to know about open enrollment:

1. Everyone is required to enroll. Pennsylvanians without existing coverage who do not enroll during the shortened 45-day window will receive a tax penalty.

If you have government or employer coverage or parental health insurance, or if you qualify for tax credits, you may be exempt from registration. Special enrollment dates are given to individuals who experience a “qualifying life event,” such as getting married or having a baby, and those who underwent hardships, such as home eviction or the death of a family member.

2. Penalties are charged for not having insurance. Penalties are withdrawn from tax refunds and are charged for each uninsured family member.

If an individual does not enroll in 2017, the penalty will be the greater of 2.5 percent of your income or $695 per adult. The penalty for uninsured children in the family will be up to $347.50. The maximum penalty is set at $2,085.

The flat and maximum amounts will adjust for inflation in 2018 and later.

3. You may change your plan. You can renew your current individual/family health insurance plan or choose a new health insurance plan through private insurance or your state marketplace. All health plans, no matter the level, must provide coverage for at least 10 essential benefits. They are:

  • Outpatient care, including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

4. Levels of insurance plans. There are four categories of health insurance plans in the marketplace: Bronze, Silver, Gold, and Platinum.

Bronze has the highest out-of-pocket expenses for services with lower premiums. Silver is the next plan, followed by Gold. The Platinum insurance plan provides the lowest out-of-pocket expenses for services in exchange for higher premiums.

5. Family size and income determine your tax credits. If your income qualifies, credits can be applied to your monthly insurance premiums. Your family income must fall from 100 to 400 percent of the federal poverty level (FPL) of the previous year.

The FPL bracket adjusts annually for inflation, and if your income changes during the year and you no longer qualify for the credits when you file your taxes, you will have to repay.