Penalties set to encourage uninsured to find health coverage

There are several ways to enroll in the Health Insurance Marketplace before the Dec. 15 deadline if you want insurance by Jan. 1, 2016.

The deadline for Health Insurance Marketplace enrollment for coverage to be effective Jan. 1 is just a week away, and the federal tax penalties for not having coverage for 2016 are the highest yet, which by design are meant to encourage eligible uninsured to enroll.

For 2016, the penalty for not having coverage is the higher of these two amounts: 2.5 percent of the yearly household income or $695 per adult and $347.50 per child under 18 with a maximum penalty per family using this method of $2,085.

Lawrence Memorial Hospital is a major sponsor of WellCommons.

Additional online resources

Cover Kansas, a project of the Kansas Association for Medically Uninsured: coverks.org

Kansas Insurance Department: ksinsurance.org

The Health Insurance Marketplace, a key part of the Affordable Care Act (ACA), was part of federal health care reform that was signed into law in 2010. The law was designed to make affordable health care and health insurance available to more individuals.

Beginning in 2014, the ACA required that almost all individuals must have health insurance or pay a tax penalty. Provisions under the ACA established a statewide Health Insurance Marketplace that provides a way for individuals and businesses to buy health insurance. Kansas has a Federally Facilitated Marketplace that utilizes the healthcare.gov website. In addition, according to the Kansas Insurance Department, coverage may be purchased from companies off the Marketplace during the open enrollment period.

As of May 1, a total of 91,381 individuals — less than 5 percent of Kansans — were covered by individual major medical insurance purchased either on or off the Marketplace, according to Kansas Insurance Department statistics. The Centers for Medicare and Medicaid Services reported in their most current weekly enrollment snapshot that as of Nov. 28, only 24,334 Kansans had selected plans using the HealthCare.gov platform, and that nationally enrollment totals were more than 2 million plan selections since Nov. 1.

Marketplace open enrollment technically ends Jan. 31, but enrollees have until Dec. 15 to get coverage that will begin on Jan.1. During open enrollment, consumers can evaluate whether to enroll in coverage, stay on their current policies or enroll in different policies.

The Kansas Insurance Department reports that in 2016 consumers shopping on the Marketplace have the opportunity to purchase from 42 individual policies offered by four health insurance companies, depending on where they live.

For 2016, the range of average rate increases is 9.4 to 25.4 percent. According to the Kansas Insurance Department, 2016 marks the first time since the Marketplace began in 2014 that insurance companies have had a full year of claims experience on which to base their premium rate revisions. The increases were explained by the fact that the coverage is guaranteed issue, companies cannot limit coverage for pre-existing conditions, there are a broad range of mandates that must be covered, prescription drug cost and other medical cost trends continue to increase, and the use of emergency rooms — which may not be the most appropriate care — continues to drive costs upward.

According to the Marketplace website, most people who apply for health insurance coverage quality for a premium tax credit that lowers their monthly insurance bill. This year, about 8 in 10 of the uninsured who are eligible are expected to qualify for financial assistance.

There are four different ways to enroll before the deadline:

  • Online at healthcare.gov. You can learn about the available plans and rates for your area. You can also estimate your out-of-pocket costs by answering a few questions about your household.
  • Over the phone at 1-800-318-2596.
  • By mailing in a paper application.
  • By contacting a navigator or other certified assister to help you with the process.

Locally there are three individuals trained as Health Insurance Marketplace navigators who are available to assist with enrollment. Heartland Community Health Center and the Lawrence-Douglas County Health Department have staff who can help for no charge. One of the Health Department navigators is also a Spanish interpreter.

To make an appointment, visit coverks.org, call the Health Department at 843-3060 or call Heartland at 841-7297.

You may be able to get coverage outside the open enrollment period if you have certain life changes — such as getting married, having a baby, losing other coverage or moving — or if you qualify for Medicaid or CHIP. Visit healthcare.gov for more information.

— Janice Early is vice president of marketing and communications for Lawrence Memorial Hospital, which is a major sponsor of WellCommons.