8 Things to Know About Affordable Care Act Enrollment

October 26, 2016 6:00 AM
A group of people under the ACA's healthcare.gov umbrella

Open enrollment for ACA coverage starts in November. Here are some facts about the sign-up process — and why, if you’re uninsured, you should explore your options.

Ten years ago, America had a big problem: tens of millions of people lacked health insurance.

Fast forward to today, and the number of individuals without coverage is the lowest it’s ever been, according to federal data.

SEE ALSO: Public to Presidential Candidates: Prioritize Children’s Health

Credit the Affordable Care Act (ACA), known to many as “Obamacare,” which changed the playing field for millions of people and insurance companies.

Signed into law in 2010, the ACA made it possible for many more people to buy insurance plans from those companies, and for more people with low incomes to get covered under Medicaid.

More than 12.7 million Americans have signed up for coverage through the ACA in the last three years. Another 10.7 million people could qualify, the federal Department of Health and Human Services says.

For those without private health insurance, participation isn’t just a way to ensure peace of mind, it’s mandatory: Those who don’t comply may end up owing more in taxes. And as always, you run the risk of major financial problems if you get seriously ill and don’t have an insurance plan to pay the doctor and hospital bills.

That’s why this time of year is so important.

The yearly ACA open enrollment period for uninsured people begins Nov. 1 — the start of a limited window when the uninsured can sign up for coverage.

Here are some key things to know about the process, which ends Jan. 31, 2017:

  1. There are many ways to do it: The main place to sign up is www.healthcare.gov — which has instructions available in English and 16 other languages. Or call 1-800-318-2596 24 hours a day, 7 days a week (except on Thanksgiving and Christmas). You also can sit down with someone who has been trained to help people enroll in ACA plans; click here for a searchable database.

  2. There’s limited time to act: If you sign up for coverage between Nov. 1 and Dec. 15, your coverage will start Jan. 1, 2017. Register between Dec. 16 and Jan. 31, and coverage will begin on the first day of the following month. The open enrollment period ends Jan. 31. After that, only certain people — including those who get married, have a new child or lose a job — can sign up before the next open enrollment.

  3. Depending on your income, coverage could be free or nearly free: If you live in a state that has expanded Medicaid, and you make less than a certain amount of money per year, you can get coverage for free or nearly free. You have to provide full information about your income, and not every state has chosen to make Medicaid open to more people, but it’s worth checking to see if you qualify.

  4. Financial assistance is available: More than 80 percent of people who buy private ACA plans will qualify for a discount on the amount they pay each month, called a premium tax credit (you can calculate what your tax credit might be here). In addition, more than half of people who buy private plans at the silver level can qualify for lower out-of-pocket costs because of their incomes.

  5. Plans can be affordable: In the end, most people who buy a plan will pay $100 a month or less (after the tax credit) in premiums, even with the newly announced premium increases. (You’ll also have to pay out-of-pocket costs (copays) when you visit a doctor, go to the hospital, fill a prescription or get a blood test or other test or scan. How much depends on your plan.)

  6. There’s a penalty for noncompliance: If you go without health insurance for most of 2017, you’ll see a tax penalty in spring 2018. (And if you didn’t have it for most of 2016, get ready for a penalty when you file your taxes this coming spring.) For both 2016 and 2017, the penalty is 2.5 percent of your income — or a flat fee, whichever is greater. The maximum penalty for a single adult is about $700, and for a family it’s about $2,100. If your income is low enough that you don’t have to file a tax return, or you meet certain other qualifications, you won’t pay a penalty.

  7. Young adults have options: If you’re 26 or younger and your parents have health insurance through their jobs, the ACA makes it possible for them to cover you on their plan. Young adults who have to buy their own coverage can opt for a special “catastrophic” plan with a low monthly premium (the amount you pay) that can offer protection in the event of a worst-case health scenario.

  8. Small businesses have options, too: There’s a special area of healthcare.gov where companies that have 50 employees or fewer can buy coverage plans for employees.

Get help with enrollment

The University of Michigan Health System has staff members trained to help anyone understand their options under the Affordable Care Act. Guidance is free, whether or not you’re a patient of a U-M doctor. Call 1-877-326-9155 between 8 a.m. and 8 p.m. Monday through Friday, or email PFC-Counselors@med.umich.edu.