Health Insurance 2017: Open Enrollment – What Your Clients Need to Know
Many clients are enrolled in employer group health policies. Information about those plans will be sent to the employee directly from their employer. However, if your client buys health insurance on their own, they have several options for purchasing coverage:
- Directly from an insurance company selling health coverage
- From their state’s health insurance exchange (visit healthcare.gov)
- On-line from private insurance offering quotes from multiple carriers
- Directly from a health insurance agent
Clients can purchase or change their coverage during the open enrollment period each year unless they experience a “qualifying life event,” such as marriage or the birth of a child.
HIGHLIGHTS FOR 2017
Open Enrollment Deadlines have changed:
INDIVIDUAL & FAMILY HEALTH PLANS
BEGINS: November 1, 2016 – ENDS: January 31, 2016
If you sign up between November 1, 2016 and December 15, 2016 the coverage starts January 1, 2017.
If you sign up between December 16,2016 and January 15, 2017 the coverage starts February 1, 2017.
If you sign up between January 16, 2017 and January 31, 2017 then coverage starts March 1, 2017.
If you don’t have insurance, you must purchase it during open enrollment if the following apply:
- You don’t have coverage through your spouse or employer
- You don’t have coverage through the government Veterans, Medicaid, or Medicare
- You are over age 26 and no longer qualify under your parent’s health insurance coverage.
- You qualify for tax credits to help you pay for health coverage.
- Look at changes
- You may receive notice about changes to your provider network, co-pays, drug coverage, or co-insurance.
- Make sure your doctor and hospital are still in network and ask about out-of-network options.
- Marketplace open enrollment is only for health insurance.
- You WILL be penalized for not having qualified health coverage.
- The 2016 penalty was the higher of $695 per adult or 2.5 % of your income
- The 2016 penalty for uninsured children is $347.50 per child.
- Maximum penalty is $2,085.
- 2017 penalties will remain 2.5% but flat amounts and maximum amounts will be adjusted for inflation
- Plans are available in 4 levels. Each level reflects cost-sharing and other factors, such as co-pays, deductibles, and co-insurance; all out-of-pocket expenses.
- Health insurance must include coverage for the following essential benefits
- Preventative and wellness care services
- Dental and Vision care for children
- Emergency care
- Lab tests
- Outpatient care & chronic disease management
- Pregnancy and care of newborn baby care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitation services
- Family size and Income determine tax credit eligibility
- Based on family size and income – contact your tax professional for information on tax credit eligibility.
- Contact your tax advisor for regarding the various circumstances that exempt you from paying a penalty.