Top 10 Things to Remember About the ACA (Obamacare) in 2015

The 2014 rollout of the Affordable Care Act was challenging and created great frustration in many insurance policy shoppers.  Technological issues hampered many and the size and scope of the changes to the health industry impacted insurers and policy holders alike.  As we near the new Open Enrollment Period we wanted to provide readers a list of key rules and issues you need to know as we begin the new plan shopping year.

In less than one month, US citizens will again be able to sign up for new health insurance for the coming year.  As of November 15th 2014, Americans will be able to examine new health insurance companies, new plan designs, and new pricing.  Open enrollment will run from mid-November to February 15th 2015, giving us only 90 days to examine the universe of options and select our plans for the remainder of the year.

10) Buy Before the 15TH

When you buy a plan before the 15th of the month, it will be effective on the first day of the following month.  Let’s say you buy a policy on December 14th, your policy will start on January 1, 2015.  If you purchase a policy on December 19th, your policy won’t begin on January 1st, it will become effective February 1st, 2015! 

9) Old Plans Are Going Away

If you purchased a health plan after March of 2010 your health insurance plan will disappear December 31st.  These “Non Grandfathered” plans don’t offer minimum essential benefits and have been described by the President as sub-standard.  The ACA requires that these plans that don’t provide minimum plan benefits go away.  Unfortunately, these plans are much cheaper and often offer low family deductibles.  These popular plans will be replaced by more expensive plans that conform to the ACA mandates.  If you have a plan that was issued prior to March, 2010 you are lucky!  Keep this plan as long as you can and as long as the insurance company keeps this plan affordable. 

Even ACA plans that were created in 2014 are not immune to change or termination.  Some insurance companies like Blue Cross are making benefit changes to existing ACA plans by tweaking their plan designs for existing policies.  Other companies like Cigna are completely removing a few of their ACA plans that didn’t sell well or had bad designs.  If you are impacted by these changes you’ll need to look at new plans and pricing during Open Enrollment.

8) If You Receive A Subsidy, Any Raise Or Bonus Must Be Reported

You knew that additional financial help from the government came with a few strings.  This isn’t a big deal, but just remember that anytime your job or financial situation changes you must call the Marketplace to notify them.  Your financial subsidy may be reduced based on your change.  If you don’t call them and have an adjustment made you could end up owing your entire tax refund or more.  The US government anticipates that more than one third of all subsidy recipients will end up owing money back to the government at the end of 2014!

7) No Health History

The Affordable Care Act changed many things about the health insurance buying process, but no change was greater than the elimination of the need for medical underwriting.  If you are healthy or very ill, you won’t be asked health information on the application.

6) Preventative Coverage Is Free

Alright, we admit it, we’ve been critical of the Affordable Care Act from day one for many important and real reasons.  One very positive development is that every qualified policy sold provides free preventative care to policy holders.  Get your annual physical exam, it won’t even cost you a co-pay!

5) Pediatric Vision Is Included In Your Medical Plan

I often get questions from clients asking about vision coverage.  If you have an ACA (Affordable Care Act) qualified plan, your policy provides for vision benefits for your children at no extra cost.  You might as well take advantage of this embedded benefit. Vision plans are available at an additional cost for adults through several ancillary providers, just ask us today! 

4) Did You Receive A Subsidy? – Say Goodbye To The 1040 EZ

That’s right, as a beneficiary of the tax credit and financial assistance you are no longer able to file the 1040 EZ form that many people use to record their taxes.  In April 2015, you’ll need to use the more complicated 1040 form to ensure your tax obligation is met for 2014.

3) Keep The Plan

Did you know that once you have obtained a health insurance plan and we are beyond February 15th 2015 you will be required to keep that exact plan for the remainder of the year.  Yes, that is correct, no switching even if you hate your plan or desire to switch to a lower deductible.  You may only change plans if you have a qualifying event like the birth of a child or a marriage.

2) No Health Plan, Lots Of Tax Problems

Unfortunately, if you didn’t buy a health plan in 2014 you not only didn’t have health coverage, you also have a tax problem!  If you have a job and your family’s income is greater than 100% of the Federal Poverty Level you will end up owing the government.  Your family will be required to pay about 1% of your income, so if your combined family income is $100,000 you may owe an extra $700 to $1,000 for 2014.  Now it is clear there is a price for procrastination!  Even worse, if you don’t purchase a qualified health plan in 2015, penalties will increase to 2% of income!

1) Better Hurry, One Time To Buy For 2015

If you don’t complete your application by February 15th, you are out of luck!  That day will be the last time you can purchase a health policy in 2015 unless you have a special triggering event like losing your work health coverage, the birth of a new child, marriage, divorce, or adopting a child!

We've tried to provide you important tips that may help you steer clear of trouble or may help you navigate issues you’ll face when working with Obamacare.  If we haven’t addressed your questions about the changes to the ACA for 2015, please feel free to click contact us or give us a call at 713-422-2935 and we'd be happy to answer other questions you may have.  If you want to get on our list we've compiled so that we'll send you a quote when new plans and pricing is available, call us today!

Jason Bohmann
Texas Health Design