Be proactive and prepared for 2016 ACA enrollment

Health Insurance

December 18, 2015

On Nov. 1, 2015, the annual Open Enrollment Period (OEP) begins, for both state-run exchanges and the Federal Marketplace. Until Jan. 31, 2016, Americans can purchase an Affordable Care Act (ACA)-approved health insurance plan.

The three-month OEP only applies to those Americans who purchase their own plans, not employer-provided coverage.  You actually need to purchase a plan by Dec. 15, 2015, for coverage to begin on Jan. 1, 2016. As per the ACA’s requirements, failing to enroll may mean paying an IRS-imposed penalty. For 2016, this will be the greater of: $695 per adult and $347.50 per child, for a maximum of $2,085 per family, or 2.5 percent of your income above the tax filing threshold.

If you do miss the enrollment deadline, you and your family may be able to avoid a penalty if you qualify for a Special Enrollment Period (SEP). These extensions begin 60 days following certain Qualifying Life Events (QLEs), including:

  • Marriage
  • Childbirth
  • Adopting a child
  • Moving to a new permanent residence
  • Gaining U.S. citizenship or lawful presence
  • Already having Marketplace coverage


What to look for in a plan

When it comes to selecting coverage, there are three key elements to consider:

  1. Plan costs These include monthly premiums, deductibles (out-of-pocket costs), copays (flat amount paid for certain services or items) and coinsurance (your percentage owed). Beneficiaries earning less than 400 percent of the Federal Poverty Level (FPL) may qualify for tax credits. And, silver level plan (the most common) enrollees may qualify for cost-sharing reductions.
  2. Healthcare providers and facilities — You should review and confirm with your preferred doctors if they’re covered within a plan’s network.
  3. Specific coverage and benefits

More people should be purchasing policies in 2016. Not only will there be fewer providers available, but more plans are deciding not to allow out-of-network benefits. Most plans’ costs will be increasing, as well. So, for this upcoming OEP, you’ll need to do your homework. Without the proper time and research, you may end up with a plan that doesn’t meet your needs.

But even though some providers leave the state-run and federal exchanges, there are still many to consider. According to the U.S. Dept. of Health and Human Services (HHS), the typical number of Qualified Health Plans (QHPs) available in a given area in 2015 is 40;  it could be as high as 100, though.

However, the Marketplace website,, may assist with your plan searches. One potential feature enables consumers to match plans according to their preferred doctors, hospitals and drugs. Another tool is being tested that would estimate various plans’ out-of-pocket costs.