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Don’t be part of the Coverage Gap—It’s time to Get Covered!

Don’t be part of the Coverage Gap—It’s time to Get Covered!

Heidi Bortner
Manager of Public Health Policy & Planning

Were you one of the millions of Americans who got health insurance coverage for yourself or your family during last year’s open enrollment under the Affordable Care Act (ACA)?  If not, here’s your opportunity!

If you make OVER $11,670 a year (single adult) or $15,730 (family of two)…

(Do you have a larger family? Check here to see what coverage you are eligible for)

  • Starting on November 15th you will have the chance to enroll or, if you did in fact enroll last year, switch plans through the Marketplace.
  • The Health Insurance Marketplace will allow you to compare plans and buy affordable health insurance coverage for yourself and your family. To sign up and to shop for coverage, click here or call the Health Insurance Marketplace hotline at 1-800-318-2596.
  • Don’t wait. Open enrollment is the only time of the year you can enroll or make changes.

Navigating the system can get quite complicated. To assist you in the process, below is a list of commonly asked questions & answers.

Q: What is the “Open Enrollment” period?
The open enrollment period for the Health Insurance Marketplace is an annual process that allows you to enroll in new benefit plans or make changes to your existing coverage. The period is open for three months, allowing you plenty of time to choose the best plan that meets your needs.

Q: Where can I go to access information about the Health Insurance Marketplace?
To sign up for greater information about the Health Insurance Marketplace, visit HealthCare.gov

Q: I need assistance completing the application. Who can I ask for help?
Individuals known as Navigators and Certified Application Counselors are available in your area to help you complete your application and answer any questions you may have about choosing plans. Visit: HealthCare.gov

Q: Do I need to do anything if I enrolled last year?
If you are not making changes to the plan that you signed up for during last year’s open enrollment period, you do not need to re-enroll. Your current 2014 benefits will remain in effect and you will be automatically re-enrolled into the same plan (unless you want to switch plans).

Q: What happens if I don’t sign up for health insurance coverage?
If you don’t sign up for coverage during this year’s open enrollment period, you may not be able to purchase health coverage for 2015 until the next open enrollment period for coverage the following year.

Q: Will I get penalized if I don’t sign up for health insurance coverage?
If you don’t have health insurance coverage during 2015, you may have to pay a penalty. The penalty in 2015 is 2% of your income or $325 per adult/$162.50 per child, whichever is more. There are certain exceptions to the penalty, click here to learn more.

Q: What are some important dates/deadlines I should be aware of during open enrollment?

  • November 15, 2014: Open Enrollment begins — the first day you can apply for 2015 coverage
  • December 15, 2014: The last date to sign up and choose a plan for coverage that starts January 1, 2015
  • December 31, 2014: Date when all 2014 Marketplace coverage ends, no matter when you enrolled
  • February 15, 2015: The last day to enroll in 2015 coverage through the Health Insurance Marketplace. The only way to get coverage through the Marketplace after February 15, 2015 will be through for a Special Enrollment Period. For more information on how to qualify for the Special Enrollment Period please click here.

If you make BELOW $16,105 a year (single adult) or $21,707 (family of two)…
(Do you have a larger family? Check here to see what coverage you are eligible for)

  • You can enroll in Medicaid (also known as Medical Assistance) — free or low-cost health coverage for some individuals, families and children, pregnant women, the elderly with certain incomes, and people with disabilities beginning on December 1, 2014
  • To learn more about Medicaid, go to Healthy PA.

Q: Is there an open enrollment period for Medicaid?
No. If an individual or family is eligible for Medicaid, they can apply at any time during the year.

Q: How do I apply for Medicaid?
You can apply for Medicaid either online, through the COMPASS website, in person at the County Assistance Office (CAO), or over the phone at (866) 550-4355. To find the County Assistance Office nearest you, please visit Department of Human Services website.

Contributed by Heidi Bortner and Shloka Joshi, Public Health Policy & Planning Unit, DBHIDS

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