Affordable Care Act’s Year Two Open Enrollment Period Brings a New Round of Questions for Consumers, Employers

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The Texas Association of Health Underwriters shares helpful information on critical dates, frequently asked questions, potential fines and purchasing assistance for the Affordable Care Act

Texas Association of Health Underwriters

Texas Association of Health Underwriters

Whether you’re an individual or an employer, utilizing the services of a professional benefit adviser does not add to the cost of coverage. You essentially receive a free service that provides professional advice, guidance and peace of mind.

While year two of the Affordable Care Act (ACA) may be absent the computer glitches and confusion that reigned in year one, consumers will face uncertainty about the process and questions regarding what many believe is the most important purchase they will make during the year. For some, the approaching open enrollment period may present the opportunity to change the choices they made, good or bad, about their coverage in year one. For individuals that didn’t purchase coverage and many employers, unfamiliarity with the new law will raise questions about coverage options and requirements that must be now confronted.

Year two of open enrollment begins on November 15, 2014, and continues through February 15, 2015. You must enroll by December 15, 2014, in order for your coverage to be effective January 1, 2015. If you purchased coverage for 2014 and you want to change your insurance plan for 2015, you must also enroll in the new plan by December 15, 2014, for it to be effective January 1, 2015.

Because there is no uniform renewal process, the steps to renew may vary among insurers. This could create confusion with canceling coverage from one company in order to select a plan with another.

If coverage is not purchased during open enrollment, consumers will be unable to purchase an ACA-compliant plan until the next enrollment period in late 2015 unless they experience a “qualifying event,” such as a divorce, marriage or change in job status that results in a loss of coverage.

“Twelve months into this process, consumers have had a chance to reflect on the decisions they made regarding their coverage for 2014,” said Jacqueline St. Hilaire, president of the Texas Association of Health Underwriters. “Many found out for the first time that they are not able to purchase ACA-compliant coverage beyond the open enrollment period. Many discovered that their coverage required them to pay higher deductibles than they had anticipated or that their doctor wasn’t in-network. Many are now accepting the fact that they could face increasing fines without coverage.”

According to St. Hilaire, questions about the process for renewal or cancellation, uncertainty about the enrollment timeline, and confusion about the transitional period allowing consumers to maintain noncompliant plans are among the growing questions being asked by consumers as they enter year two of life with a federal health coverage mandate.

St. Hilaire added, “Until last year, a very high percentage of individuals have never had to make choices about deductibles, co-pays and levels of coverage. Many now realize the importance of taking the time to closely review their options and to seek guidance in order to make the right choices for their families, budgets and their future.”

An Aflac study of the 2013 enrollment process suggests that many didn’t approach the purchase of their health plan as they might for that of a car or vacation. The study found that 41 percent said they spent less than 15 minutes researching their health insurance plan options in 2013.

For some, renewal may be a mere formality, but that process could be tricky with consumers unsure of what to expect. For others, the process of cancellation in order to select another health plan must be done carefully to ensure there is no lapse in coverage.

Those who received subsidies may be hit by a financial aftershock that can reduce the amount of any tax subsidy used to offset the insurance premiums. These aftershocks could even include asking insured people to pay the IRS back for the subsidies they’ve received. The subsidies are based strictly on income; so as someone’s income goes up or down, so will their actual subsidy. If someone has had an increase in income, their subsidy will be recalculated to go down. If that person received a larger subsidy than he should have, after it’s all recalculated, the IRS may be asking for some of it back.

For employers, year two brings questions, obligations and possible fines of up to $3,000 per employee, depending on the size of the company.

“Many employers are facing new requirements for the first time. The complexity of their options can be overwhelming and the cost of a wrong decision could be significant for their businesses,” stated St. Hilaire. “Employers would be especially wise to seek the counsel of a professional benefits adviser in order to make the best choices for their company and employees.”

She added, “Whether you’re an individual or an employer, utilizing the services of a professional benefit adviser does not add to the cost of coverage. You essentially receive a free service that provides professional advice, guidance and peace of mind.”

Individuals and employers interested in locating a professional benefits adviser in their community who can assist with questions about year two of the Affordable Care Act may go to Find an Agent.

Texas Association of Health Underwriters (TAHU) is a state trade association representing licensed health insurance agents, brokers, consultants and benefit professionals who serve the health insurance needs of employers seeking health insurance coverage. TAHU is a state chapter of the National Association of Health Underwriters.

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