A major provision of the Patient Protection and Affordable Care Act (ACA) was the creation of state-based and federal Health Insurance Exchanges for individuals and Small Business Health Options Programs (SHOPs) for small businesses. Beginning November 15, 2014, enrollment in Health Insurance Exchanges and SHOPs will be available. The open enrollment period ends February 15, 2015.

Individuals and small business owners can use Health Exchanges and SHOPs to compare health plans for benefits and price, and select a plan that fits their needs. Coverage begins the first day of the next month for those enrolling between the 1st and 15th days of the month; otherwise, coverage starts the first day of the second following month. So if an individual enrolls on January 16, coverage begins March 1.

Most people must have health coverage or pay a fee. If you don’t have coverage in 2015, you’ll pay a penalty of either 2% of your income, or $325 per adult ($162.50 per child) – whichever is higher. You are considered covered under the health care law if you have any job-based plan, any plan you bought yourself, Medicare, Medicaid, CHIP, and many other kinds of coverage. See a full list of plans and programs that meet the health law’s coverage requirement. https://www.healthcare.gov/fees-exemptions/plans-that-count-as-coverage/. Some people qualify for an exemption from the fee based on income or other situations.

If you are eligible for job-based insurance, you can consider switching to a Marketplace plan. But you’ll qualify for premium tax credits and other savings based on your income only if the job-based insurance isn’t considered affordable or doesn’t meet minimum value requirements. If you have Medicare, you can’t use the Marketplace to buy a supplemental plan or dental plan. You can buy a plan outside the Marketplace and still meet the health care law’s coverage requirements. But if you buy outside the Marketplace, you won’t be eligible for premium tax credits or other savings based on your income.


Re-cap of Key dates:

  • November 15, 2014: Open Enrollment starts — the first day you can apply for 2015 coverage
  • December 15, 2014: The last date to enroll for coverage that starts January 1, 2015
  • December 31, 2014: Date when all 2014 Marketplace coverage ends, no matter when you enrolled.
  • January 1, 2015: The date 2015 coverage can start if you apply by December 15, 2014, or if you accept automatic enrollment in your existing 2014 plan or a similar plan. 
  • February 15, 2015: The last day to enroll in 2015 coverage. If you miss this deadline, you can’t sign up for a health plan inside or outside the Marketplace for the rest of 2015. The only exception is if you qualify for a Special Enrollment Period (SEP).

After open enrollment ends, you can enroll in a private health plan through the marketplace ONLY if you qualify for a SEP due to changes to your household, income, and some other factors. If you think you qualify for a SEP, use the healthcare.gov website’s screener to find out if you qualify. https://www.healthcare.gov/screener/

So, if you need healthcare or want to review your existing policy with alternatives, now is the time to do so.