Health Insurance

from Rhodes-Warden Insurance

Health Insurance

What is Open Enrollment and how does this affect those that are not enrolled in a health plan as required by the health care reform law also known as Obamacare?

Open Enrollment is the period of time during which individuals that are eligible can enroll in a qualified health insurance plan. In Oregon, some individuals purchased their coverage directly from an insurance company through a licensed health insurance agent or applied and enrolled for insurance coverage through our nation's insurance marketplace, Healthcare.gov.  The open enrollment period for this year ended on February 15, 2015.

For those that did not purchase health insurance coverage as required by law, the next open enrollment period for 2016 coverage will be November 15, 2015 to February 15, 2016.

If you did not purchase a qualifying health plan during this past open enrollment period, you will probably have to pay a penalty fee. This penalty fee, also knows as the “individual responsibility payment” is arrived at in one of two ways. If you or your dependents don’t have insurance that qualifies, you’ll probably have to pay the higher of these two amounts:

  • 1% of your household’s yearly income (certain rules apply so speak with your tax advisor)
  • $95 per person for the year and $47.50 per child under 18 with a maximum penalty of $285

The penalty fee increases every year. In 2015 it will be 2% of household yearly income or $325 per person. In 2016 and beyond, it will be 2.5% of income or $695 per person. You’ll pay the fee on your 2014 federal income tax return that most people will file in 2015. For more information about the “individual responsibility payment” please visit the Internal Revenue Service website or speak with your tax advisor. There are certain situations in which you may be exempt from the penalty fee so be sure to ask your tax advisor when preparing your 2014 tax return.

Even so, some individuals who did not enroll during the last open enrollment period, may qualify for “Special Enrollment” if they experience a “Qualified Event” that involves a change in status such as marriage, divorce, birth of a child or loss of other health insurance coverage. If you don’t have an event that qualifies you for special enrollment, you won’t be able to buy insurance until the next Open Enrollment Period.

There are some things you should know about Special Enrollment before you apply. The first is to make sure you qualify. Here are some examples of qualifying events. There are other more complex situations that may qualify you for special enrollment, so be sure to contact us to get help determining your eligibility:

  • Marriage
  • Having or adopting a baby
  • Gaining citizenship
  • Leaving incarceration
  • Losing other health insurance coverage
  • Divorce
  • COBRA expiration
  • Aging off of a parent’s health policy
  • Losing eligibility for Medicaid
  • If you voluntarily end your coverage
  • Acquiring status as a member of a federally recognized Indian tribe

Understanding the changes our new health care form law presents and how they affect you can be complicated. Here at Rhodes-Warden Insurance, we understand the new law and have been preparing for it since its passage in 2010. We are here to help make purchasing your health insurance coverage a little less stressful during the next Open Enrollment period or your Special Enrollment. If you have any questions or would like to more information about health care reform, please contact one of our office located in Lebanon, Albany or Stayton, Oregon.