With the Affordable Care Act (ACA) plan open enrollment and tax extension special enrollment done, now is the time to look to the off season and what you as an agent can do to continue educating and enrolling your clients.
Qualifying Life Events
Many individuals who are currently covered by a creditable health plan will experience life changing events in the off season that may open up options for them to switch plans or gain health coverage outside of open enrollment. Letting your clients know that they have options outside of open enrollment will be one key to success in the off season.
Current Qualifying Life Events (QLE) are available up to 60 days from the Qualifying Event:
- Having a baby, adopting a child, or placing child up for adoption
- Getting married
- Losing other health coverage
- Being denied Medicaid or CHIP coverage
- Moving the residence outside the current insurance plan’s service area
- Gaining citizenship
- Members of federally recognized Indian tribes can enroll in or change plans once a month throughout the year
- Leaving incarceration
- Individuals already enrolled in Marketplace coverage – having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions
Short Term Policy Season
If none the qualifying events apply to your clients or they don’t have creditable coverage, you may still be able to help them obtain coverage through a Short Term Plan. Short Term health plans generally have a coverage time of 30 to 360 days, offer a range of deductibles and coinsurance options to choose from, in and out of network coverage, and are available for individuals and families.
Good Prospects for Short Term Policies
- Looking for an alternative to ACA plan coverage
- Recent college graduates
- Part-time or temporary employees
- Between jobs and looking for an affordable alternative to COBRA
- Newly employed and waiting for health benefits to begin
- Recently retired and waiting for Medicare eligibility
Short Term medical plans differ from ACA plans. Short Term plans are still underwritten, are not deemed creditable coverage per the ACA, do not cover preventative care for free, and do not cover pre-existing conditions. Be sure that your clients who enroll into a Short Term plan are aware of the ACA penalties they may face for not having creditable coverage.
ACA Penalty Information
Per the ACA, individuals who are not enrolled in a creditable plan for 9 out of the 12 months per year are subject to a penalty. The penalties vary based on the household size and income, and are deducted from individuals’ tax returns.
2015 ACA Penalty
If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:
- 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
- $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.
2016 ACA Penalty
If you don’t have coverage in 2016, you’ll pay the higher of these two amounts:
- 2.5% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
- $695 per person for the year ($347.50 per child under 18). The maximum penalty per family using this method is $2,085.
Education and Opportunity
Now is the perfect time for agents to become educated about the ACA and to use this opportunity to reach a much larger base of individuals and families. Contact JSA’s expert staff at 1-800-203-0433 to learn how to utilize your book of business to jump start your ACA business, and how to develop new clients.
– John Gallagher
Links For Information:
ACA Penalties: https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/
Qualifying Life Events: https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
