Maybe you have always had health insurance through your employer or your spouse’s employer, and now that option isn’t available. Or maybe you have always been on a parent’s health plan, and now you’ve aged out of that option. Whatever the issue is, now you’re here, and you need to figure out what you are going to do for health insurance in 2018.

We know that you have plenty of questions, so we sat down with our subject matter experts here at Keenan to address some of the most commonly asked questions that we hear from people shopping for coverage. We want to ensure you have the information you need to make the best decision for your health care needs. Health insurance made easy means being educated on the issues.

1. What is the penalty for not having health insurance?

Okay, first and foremost you want to know if there is a financial benefit to opting out of having any coverage. After all, you feel you’re healthy and you don’t anticipate needing to go to the doctor this next year. Channeling our inner parental voice, we’d sit you down and throw out some flowery advice like, “an ounce of prevention is worth a pound of cure.” But we all know that facts are better than the stern parent lecture. So, just the facts…

Despite multiple bills that were floated in Congress throughout 2017, penalties for not having health insurance are still in place. Here’s the basics:

• Penalty amounts for the 2018 tax year have not been announced yet, but they are expected to be equal to or greater than the 2017 tax year penalty.
• If you did not have health coverage in 2017, the penalties were 2.5% of your total household adjusted gross income, or $695 per adult and $347.50 per child, up to a maximum of $2,085.
• Certain plans do not count as having health insurance coverage (e.g., only dental and vision, catastrophic coverage that only covers for a specific illness, plans that only offer discounts on medical services, etc.), so it is important to make sure that you have a “qualified” individual health care plan.

So, ouch! I don’t know about you, but if I have to pay anyway, I might as well get something for my money.

2. How long is the Open Enrollment period?

Our stern lecture on the numbers worked? Well, even if it didn’t yet, you still might want to know what to do if you decide to purchase health insurance. So next up is the enrollment period. In California the Open Enrollment period begins on November 1, 2017 and runs through January 31, 2018. If you live outside of California (and a few other states), your Open Enrollment period has been shortened significantly this year. The federal government’s open enrollment period has been slashed by about 45 days, and runs from November 1, 2017 through December 15, 2017.

Even if you live in California, or one of the other states with extended deadlines, it is important to purchase your coverage earlier rather than later, in order to ensure that your coverage is valid on January 1, 2018 and avoid any possible penalties.

3. What can I do during Open Enrollment?

The Open Enrollment period lets you:

• renew your current individual or family health care plan;
• choose a new plan through the health exchange; or,
• purchase a qualified individual/family plan through a private insurer.

4. What if I miss the Open Enrollment period?

If you miss the Open Enrollment deadline, you won't be able to sign up for coverage unless you qualify for a special enrollment period.

The qualifying events for a special enrollment period include:

• divorce
• marriage
• birth or adoption of a child
• death of a spouse or partner that leaves you without health insurance
• your spouse or partner who has you covered loses his/her job and health insurance
• you lose your job and with it your health insurance
• your hours are cut making you ineligible for your employer's health insurance plan
• you are in an HMO and move outside its coverage area

5. What is included in a qualified health care plan?

All qualified health care plans must include at least ten essential benefits, which are:

• Outpatient care including chronic disease management
• Emergency care
• Hospitalization
• Pregnancy and newborn care
• Mental health and substance abuse services
• Prescription drugs
• Rehabilitation services and devices
• Lab tests
• Preventive and wellness services
• Dental and vision care for children

6. Are there subsidies to offset the cost of health insurance?

Yes, there are subsidies / tax credits for health insurance. Whether or not you qualify for these tax credits is dependent on your family size and income. To qualify, your family income must fall between 100 and 400 percent of the Federal Poverty Level (FPL).

We know this sounds a little complicated, so here is a simple example.

• Family of four with an income between $24,300 and $97,200 in coverage year 2017 would qualify for these credits.
  • The government uses FPL standards from the previous year to determine eligibility.
  • For 2018 coverage for a family of four, the income bracket adjusts to $24,600 to $98,400.

If you qualify, the credits can be applied to your monthly insurance premiums. If your income changes during the year and you no longer qualify for the credits when you file your taxes, you will have to repay those credits.

The amount of the subsidy you qualify for depends on the number of members in your household, where you live, your household income, and the age of each household member. You can use the KeenanDirect subsidy calculator to estimate what you qualify for.

We know that this might only answer some of your questions, so let us know how we can help you out. We’re here for you to make health insurance easy!