Last Call to Enroll for 2016 Insurance Under the Affordable Care Act

 

THIS weekend is the final deadline to sign up for health insurance coverage this year under the Affordable Care Act.

If consumers don’t sign up at HealthCare.gov by midnight Pacific time on Sunday — that’s 3 a.m. Monday on the East Coast — they must wait until the fall, and their health coverage won’t start until 2017. (States that run their own insurance marketplaces have similar deadlines.)

In December, HealthCare.gov extended the deadline (for coverage starting Jan. 1) by two days, because of a last-minute surge in enrollments. But there’s no indication that will happen again.

“We’d encourage consumers not to rely on a possible extension, but to plan for the deadline,” said Cheryl Fish-Parcham, private insurance program director at Families USA, a consumer advocacy group.

If consumers enroll by the Sunday deadline, their health coverage will start March 1.

Those who miss the deadline can sign up later for 2016 coverage only if they have a qualifying circumstance, like getting married, having a baby or losing job-based health coverage.

Last year, taxpayers who missed the open enrollment deadline were allowed to sign up later if, when filing their income tax return, they were surprised to learn that they would have to pay a penalty for not having coverage. But there will be no special “tax time” enrollment option this year, the government has said.

In addition, the government may start doing more to verify that consumers are truly eligible to sign up during special enrollment periods. Insurers have complained that the government has been too lenient in allowing consumers to sign up after open enrollment, making it difficult to manage plan costs.

It’s not clear what documentation may be required, said Sabrina Corlette, a health care researcher at Georgetown University. But after Sunday, she said, “People should not be surprised if they start getting asked to provide some form of proof” that they qualify.

As the Sunday deadline approaches, consumers can get help by phone 24 hours a day by calling 800-318-2596. Or they can find in-person help in many areas over the weekend. To find a site nearby, visit LocalHelp.HealthCare.gov. Some locations may require an appointment, but others will accept walk-ins.

“We have been busy,” said Pranay Rana, a consumer education specialist in Atlanta with the nonprofit group Georgians for a Healthy Future. Enrollment help will be available over the weekend at a variety of locations, he said, including community centers and churches.

Here are some questions and answers about coverage:

■ What is the penalty for not having coverage in 2016?

The penalty for not having coverage this year is $695 per adult, or 2.5 percent of household income, whichever is greater. (That’s up from $325, or 2 percent of household income, for 2015.) If you sign up for coverage by Sunday and keep it for the rest of 2016, you won’t have to pay a penalty when you file your taxes next year. The law allows you to have short-term gaps in coverage without paying a penalty.

■ If I was automatically re-enrolled in the plan I had in 2015, can I still change my plan for this year?

Yes. You can change your plan selection if you act by the Sunday deadline.

■ If I had marketplace coverage last year, do I need to do anything special when filing my taxes?

If you had coverage through the Affordable Care Act in 2015, you’ll be mailed a statement with information you’ll need to file your income tax return. HealthCare.gov advises that you wait to file your return until you receive the form, which should arrive by early February. Source