By Karen Pallarito
THURSDAY, March 13, 2014 (HealthDay News) — Still thinking about signing up for insurance under the new U.S. health care law? You’d better act quickly because the enrollment deadline to obtain coverage this year is March 31.
Not only will you obtain health insurance, but if you are currently uninsured and select a marketplace health plan before the end of the month, you’ll avoid new federal tax penalties for not having coverage. This so-called individual mandate is a key feature of the Affordable Care Act, often called Obamacare.
“I think a lot of people are either hoping that the individual mandate goes away or . . . they’re just ignoring it,” said Jim Carleton, an enrollment specialist with Tri-Town Community Action Agency in Johnston, R.I., one of the state’s health insurance navigators.
With little more than two weeks left in this year’s open-enrollment period, now’s the time to get serious. Here’s what you need to know to get signed up.
Pay attention to upcoming enrollment dates.
The Affordable Care Act created federal and state marketplaces where consumers can shop for a health plan. These marketplaces for health plans are only available for a limited time each year.
If you select a plan by March 15, your coverage will begin on April 1. But if you sign up between March 16 and the end of the month, your coverage won’t kick in until May 1.
“We’re going to try to get people to enroll by the 15th at all costs because one month without coverage could be devastating to people,” said Mark Colwell, director of consumer marketing at GoHealth in Chicago, a web-based health insurance broker whose licensed advisers help consumers enroll in marketplace plans.
If you miss the March 31 enrollment deadline, you’ll have to wait until the next open enrollment period, beginning Nov. 15, to obtain coverage starting in 2015.
Exceptions: You can sign up after March 31 if you have some special circumstance, such as a marriage, divorce or birth of a child.
There’s no deadline for enrolling in Medicaid or the Children’s Health Insurance Program, which are publicly funded programs for the poor.
Take advantage of premium assistance.
If your income falls within a certain range, you can use federal tax credits to lower your monthly health-plan premium, but only if you buy a plan through the Affordable Care Act’s federal and state marketplaces.
People who earned less than 400 percent of the federal poverty level last year — $45,960 for an individual or $94,200 for a family of four — can qualify for the tax credit. The amount of assistance depends on your household income and family size.
“I actually have families that qualify for as much as a $1,200-a-month subsidy. You can’t walk away from that kind of money,” said Joe Partise, of Joe Partise CLU & Associates, a Garden Grove, Calif.-based certified insurance agent for the state health marketplace, Covered California.
Tip:What if you don’t qualify for a tax credit or it’s too small to make much difference? You may want to shop for a health plan outside of the marketplaces, Partise suggested. “There’s less steps and there’s less opportunity for things to go wrong and fall through the cracks,” he said.
Don’t ignore out-of-pocket costs.
All marketplace plans offer essentially the same core benefits. The key difference is what you’ll pay for coverage, advisers say. In addition to the monthly premium, people need to consider the annual deductible and any copayment or coinsurance amounts they’re likely to shell out.
If you choose a so-called “bronze” plan, you’ll probably have a lower premium, but you’ll pay more out of pocket for medical services. With a “gold” plan, your premium may be higher, but it will cover a greater share of the expenses when you receive services.
Curt Fackler, a manager at Better Health Together, a community-based health-care collaborative in Spokane, Wash., likes to help people select a plan by comparing three options. “When you put them side by side, it sure makes it a lot easier,” he said.
Tip: Some lower-income individuals and families can qualify for reduced cost-sharing amounts, but only if they choose a “silver” plan.
Know who’s in the network.
If seeing certain doctors or using a particular hospital is important to you, make sure your providers are in the health-plan network.
Provider networks in marketplace plans are often skimpier than those available outside of the marketplace, advisers said. The decision then becomes a trade-off.
Some people want a certain doctor “no matter what,” said Partise. Others say, “if it comes down to dollars and cents, I’ll find somebody new,” he explained.
Tip: If your health-care provider is not in the plan you choose, you can go out of network for care. But depending on the plan, you’ll pay a lot more, or maybe all, of the cost.
Get help if you need it.
Every state has people to assist consumers completing an application for coverage and enrolling in a health plan through the federal HealthCare.gov website or through their state health marketplace.
“We want to get people in the plan that best suits them and their budget,” said Tri-Town’s Carleton.
Licensed insurance agents and brokers can also help with selecting and enrolling in a plan.
Tip: Go to localhelp.healthcare.gov and enter your city or ZIP code to find help near you.
Go to HealthCare.gov for more tips on choosing a health plan.