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.