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Chamber Chatter

Open Enrollment for Individuals

Open Enrollment for individuals & families starts its 3rd year on November 1st and the time to purchase or change plans has been compressed into a 3-month period.

Here‘s what you need to know:

 To secure a January 1st effective date, you must enroll and pay for a plan by December 15th. (Just a 45 day period!) For example:

  • December 16th – 31st secures a February 1 effective date
  • To secure a February 1st effective date, you must enroll and pay for a plan by January 15th
  • January 16th – 31st, secures a March 1st effective date


If you miss Open Enrollment, the only way to purchase a Health Plan is by having a “Life Qualifying Event” such as losing employer or credible coverage, moving to a new service area, marriage, having a baby, etc.

This year many health plans will not be renewed and over 200,000 Coloradans will lose their plans…WHY?

  • The CO Division of Insurance declared that “grandmothered” plans or plans purchased from March 2010 – December 31st, 2013 will terminate this year.
  • The ACA’s new requirements has forced carriers to update their plans to meet the new plan criteria.
  • Colorado HealthOP is not able to sell plans in 2016 so if you own a HealthOP plan you must shop for a replacement.

Many carriers have changed their networks, added new networks and modified their formulary plans (drug plans), so be sure to check if your docs and meds are covered in a plan before you purchase!

The Penalty is increasing in 2016 for not owning a Credible Health Plan.

You cannot exceed 90 days without coverage and the 2016 penalty is either $695/person or 2.5% of your income, whichever is higher.

If you are a business

There are no Open Enrollment mandates so you can purchase a plan for your company at any time.

If your business will exceed 50 Full Time Equivalent Employees in 2016, you must offer a credible, affordable plan to your “eligible” employees. Eligible employees could be a different total than Full Time Equivalent employees.


There are many choices and strategies to minimize impacts.

For more information on the mandates, plan quotes, ACA information, I’m happy to help!

Neal Gold


Group Insurance • Individual & Family • Life Insurance • Disability • Medicare Plans
Health Reform Guidance & Information/Health Plan Reviews

“You can trust us to find the solution for you.”

How to understand individual health insurance for 2016

By Neal Gold, Gold Health & Life

(Note: Neal Gold is a trained expert on navigating the current healthcare system. He is licensed with all health insurance carriers and plans and is certified with the Connect for Health Colorado insurance exchange.)

With all the noisy rhetoric about healthcare in the U.S., it is common for individuals to feel intimidated or uneasy about their 2016 health insurance. With the Republicans assuming control of the U.S. House and Senate, will the Affordable Care Act be repealed? Will my plan from 2015 automatically renew? Are rates going to skyrocket?

In short, the Affordable Care Act as an entity is not going anywhere in 2016. It is federal law and if legislators debate and agree to changes, portions of the law may be affected, but it is not going away. Some health insurance plans from 2015 do not automatically renew. Not all plans from 2015 will be available in 2016. Some rates from 2014 will rise, some rates will decrease; it all depends on the individual carrier and plan.

The good news is that with some simple research and planning, there is a solution for practically any situation. The first step is to understand some key points and deadlines to make your coverage seamless for 2015.

Know the deadlines and avoid a gap in coverage:

  • November 15, 2015: The first open enrollment day you can purchase a plan for an effective date of January 1, 2016.
  • December 15, 2015: The last open enrollment day you can purchase a plan for an effective date of January 1, 2016.
  • February 15, 2016: reflects the end of this open enrollment season and is the last day you can purchase or change plans. If you miss this deadline, you will not be able to buy a plan until the next open enrollment period for 2016, unless you have a qualifying life event.

If you miss the December 15 deadline for a January 1 effective date, you can still purchase a plan through February 15, but there may be a gap in your coverage until your new effective date.

Renewal options:
Carriers and Connect for Health CO should have sent a notice to customers by mid-November informing them if their 2015 plan is available, 2016 pricing and options if it is not. If you receive a tax credit, please note that any changes will impact your premium. Customers are not bound to stay with the same carrier in 2016  and there are many options that may be less costly or improve your coverage.

The penalties for not having health insurance coverage in 2016 are more punitive from the 2014 penalties and will be the higher of these two calculations:
• Two percent of your yearly household income.
• $325 per person for the year; 162.50 per child under 18. The maximum penalty per family using this method is $975.

New Options/Costs:
Take time to compare plans. You need to consider and understand out-of-pocket costs such as prescription medications, deductibles and copays. Options are many: PPO, EPO, HMO, NPOS, LocalPlus, HSA. Networks have changed, so be sure your providers are included in the plan and be prepared if you travel frequently. Having solid knowledge of your needs will help you find a suitable, affordable plan.

Navigating this process can be easy with the right help. I will gladly decipher your options at no cost to you. Simply contact me at 303-818-0321 or neal@goldhealthandlife.com and together we can dial in a great start to 2016 for you.