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On How to Avoid Challenges and Added Costs of Open Enrollment Period for 'Obamacare'

October 31, 2014

If you live in the U.S., consider this a type of public service announcement. We are about to enter the open enrollment period for 2015 as part of the continuing rollout of the Patient Protection and Affordable Care Act (PPACA), which has become better known as “Obamacare.” As we are all aware, the initial rollout of Obamacare was problematic—to put it politely. However, the good news is that, thanks to some great work by the IT industry experts called in to fix it, healthcare.gov is working better and is seemingly ready for the expected open enrollment tsunami. In fact, the opening of the enrollment period should be a good stress test of the patched system.


In this regard, a few words of wisdom for those looking to check things out, and possibly sign up, during the open enrollment period should prove helpful. Sandra Horn, president of ACA Marketplace Enrollment Solutions (ACAMES), a national enrollment firm that is not affiliated with any governmental agency, has some timely tips.

“People will be renewing their health insurance policies at the same time that others are enrolling for the first time,” Horn explains. “In fact, according to a recent study by the Kaiser Family Foundation, 89 percent of the nation’s uninsured are unaware that open enrollment begins Nov. 15. With all of the many factors facing consumers, working with a licensed insurance professional, such as the ACAMES enrollment firm that specializes in the Health Insurance Marketplace, is more important than ever.”

One of the things that Horn points out is the need to avoid higher penalties by enrolling in a healthcare plan by acting during the open enrollment period which begins on Nov. 15, 2014 and runs through Feb. 15, 2015. For those familiar with the “individual mandate” provision of the PPACA, you are aware that it requires Americans to obtain health insurance or pay a penalty.  

Said penalties are:

  • In 2014, the penalty for not obtaining health coverage was $95 per adult and $47.50 per child up to $285 per family, or one percent of taxable family income, whichever was greater.
  • In 2015, the penalty increases to $325 per adult and $162.50 per child up to $975 per family, or two percent of taxable family income, whichever is greater.

As ACAMES points out, many Americans run the risk of being caught off-guard at tax time when they realize that they owe a penalty for not having purchased coverage in 2014, and it may be too late for them to do anything about their 2015 penalty when they file their 2014 taxes.  

ACAMES’ advice about working with a licensed insurance professional to understand the rules and options is something to consider.  PPACA and getting signed up for the right insurance while pitched as being simple has proven a challenge to many people looking to enroll on a plan that makes sense for them. While healthcare.gov does provide voice access for advice about what to do, it is never a bad idea to get a second opinion. This is particularly the case if you are not finding it simple to get your questions and concerns answered or if holding times because of the expected influx to the government sites are too long.   

As noted, this is a good time to mark your calendars regarding the open enrollment dates, as well as make sure you have a full understanding of the process, plans and penalties. As the ACAMES tips highlight, not only are governments ready this time around but so are companies willing to help consumers determine subsidy eligibility, review benefits and plans and assist in getting them enrolled. 




Edited by Alisen Downey



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