ACA open enrollment – The Basics


Open enrollment for the Affordable Care Act started on November 1, 2015. The first and most important deadline is December 15, 2015. You must enroll or make changes by this date in order for a new policy to take effect by January 1st. Before making a decision, here’s what you need to know about this coming year’s open enrollment:

  • Enrollment for the ACA Marketplace for 2016 runs from November 1, 2015 to January 31, 2016.
  • Consumers can enroll inside or outside of the Marketplace.
  • This ACA open enrollment period applies to new enrollees or those wishing to make changes in last year’s plans or coverage options.
  • Open enrollment is the only time a consumer can enroll in a medical plan (which counts as minimum essential coverage or MEC), switch plans, or apply for assistance with costs, or subsidies.
  • Log onto to access programs by state.
  • If you have Medicare you cannot purchase a new individual policy.

When does coverage start?

A person enrollingMoney and time paid picture dreamstime_m_38644784 November 1, 2015 to December 15, 2015 will see a start in coverage as soon as January 1, 2016.

A person waiting until January 15, 2016 to enroll or change plans will start new coverage on February 1, 2016.

Anyone who enrolls or change plans between January 16, 2016 and January 31, 2016 will have new coverage taking effect on March 1, 2016.

The open enrollment period of the ACA Marketplace will end on January 31, 2016.

If you don’t enroll in a plan the ACA considered minimum essential coverage (MEC) by January 31, 2016, you will not be able to enroll in a health insurance plan for the entire year unless you qualify for a special enrollment period.

A few tips for navigating the ACA marketplace

#1 Subsidies to help with premium costs can only be obtained through the health insurance marketplace.

#2 The law requires individuals to obtain minimum essential coverage, and must carry that coverage through the year to avoid paying a per month fee when not insured. The only way to avoid this fee is to gain an exemption. Any plans offered by the marketplace are considered minimum essential coverage.

#3 If you missed the initial enrollment period, you are unable to sign up again until the next open enrollment, except in the case where you can qualify for a special enrollment. For example, a person who was unable to qualify for Children’s Health Insurance Program (CHIP) or Medicaid may be able to qualify for a special enrollment. Losing employer based insurance or COBRA are also considered qualifying events.

#4 Medicaid and CHIP does not have a limited enrollment period. Consumers can apply at any time.

What’s considered minimum essential coverage?

The ACA considers minimum essential coverage a type of health plan (includes individual policies) bought within the health insurance marketplace, other sources, received from a job, or from Medicare, Medicaid, CHIP, TRICARE (military), and others. The ACA does not consider the following as minimum essential coverage in order to avoid fine:

  •  Vision and dental care only
  • Worker’s compensation
  • Medical service discount plans
  • Specific disease or specific condition coverage only

What about penalty fees?

Entering its third year, Affordable Care Act coverage costs continue to increase. National average premium costs are expected to rise by approximately 7.5% that use the marketplace. Premiums for large insurers are expected to rise 25% to 43% in other states, including Tennessee, Oregon, South Dakota, and Maryland. High deductibles have also soured enthusiasm for many, with deductibles averaging $3,000. However, a Bronze plan comes with a deductible of $5,731 while Silver plans average $3,117. As deductibles decrease, premiums increase. Before coverage even begins these high deductibles cause financial strain that leads to hard decisions and choices for many.

The penalty fee for not having health insurance coverage in 2016 will be charged for every month you are not covered. Fees are calculated in two ways: either as a percentage of household income – 2.5% of household income or the total yearly premium that an average bronze plan would cost. Or a per person fee ($695 per adult and $347.50 for children under 18 years of age) with a maximum fee of $2,085. You’ll pay whichever is higher.
The IRS will hold back penalty fee amounts from future tax refunds, but consumers will not face criminal penalties, levies, or liens against them if the fee is not paid.