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Chamber Chatter

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 With the Republicans assuming control of the U.S. House and Senate, will the Affordable Care Act be repealed?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.