Open enrollment for health care insurance, whether you’re getting benefits through an employer, a state program, or are self-funding, has never been an easy proposition—and adding the Affordable Care Act (aka “Obamacare” or “ACA”) to the mix in recent years has not simplified things a bit.

From what you read online or hear in the daily news, together with what you think you know from trying to keep up on all the changes, information, and misinformation, it’s enough to drive any reasonable person . . . well . . . bananas (monkey pun intended)!

Barrel O’Monkeyz “friend” Wayne Neale is an experienced insurance professional who works for Truscott Benefits Insurance Services in Trabuco Canyon. He offers the following 10 factoids to help the many Monkeyz Blog readers who are small business owners, entrepreneurs, and solo professionals make sense of health insurance enrollment, the ACA, and various options for getting low rates for good coverage.

  1. The ACA has greatly “seasonalized” health care enrollment for everyone. In fact, 80% of all health insurance enrollment now takes place from mid-October through early January. So be sure to submit your enrollment or changes early to avoid the bottleneck of administrative work.
  2. Health insurance is now required. A good insurance agent or broker will provide you a free education and make you a better consumer. Know your options and if you are an employer, know what is required of you.
  3. Typically, the services provided to you by health insurance agents or brokers are FREE. Commissions are built into the premiums you pay. Those premiums are the same if you go direct or through an agent/broker. To be safe, however, make sure to ask if you will be responsible for any additional fees. (P&C brokers tend to add additional fees for their services.)
  4. If you already have health insurance through am employer, chances are you don’t need and/or don’t qualify for coverage through the ACA. If you have employer coverage, you should consider buying a plan through the Health Insurance Marketplace only if your employer plan does not meet certain standards, also known as “qualifying coverage.” If your employer offers a qualified plan, you will not be eligible for any subsidies in the Marketplace.
  5. Under the ACA, employerswith 50 or more full time equivalent (FTE) employees are required to provide qualified health coverage or face tax penalties. 
  6. If you’re self-employed, you can enroll in a health insurance plan through the individual Health Insurance Marketplace OR buy on the private market directly from the carriers. The main reason to purchase coverage through the Marketplace would be if you qualify for a government subsidy. You will have a larger selection and better service working with your agent going directly to the carriers.
  7. The 2017 Individual & Family Plan (IFP) open enrollment season begins November 1, 2016. This is the first day you can enroll, re-enroll, or make changes for plans that renew or begin January 1, 2017. December 15, 2016 is the cut off for plans starting January 1, 2017. January 15, 2017 is the cut off for plans starting February 1, 2017.
  8. Qualifying Events, aka “Special Enrollment Periods,” are the only times you can enroll or make changes outside of open enrollment. These events include loss of coverage, getting married, and having a baby. Loss of coverage due to loss of a job is most common. In this situation, you may qualify for a subsidized plan on the Marketplace, which would be much more affordable than COBRA.
  9. If you choose not to get health insurance, the so-called individual mandate requires that you pay a penalty or fine. In 2016, the fee was 2.5% of household income or $695 per adult and $347.50 per child under 18 up to a maximum of $2,085. Penalties for 2017 have not been published, though they are expected to keep pace with inflation.
  10. As we have all heard, either in the news, or through the grapevine, the Health Insurance Marketplace is not perfect. There are technical glitches and long processing periods at times. Do not wait until the last minute to enroll. If you know you will need coverage through the ACA start the enrollment process as soon as possible, preferably with an agent or broker who can help you navigate the system. If you don’t qualify for a subsidy on the Marketplace, know that there are more options if you go to the private market.

Still Got Questions?

Visit the Health Care Marketplace or contact Wayne at (949) 215-0196 or  [email protected]tbenefits.com.

Paul June is King Monkey of BARREL O’MONKEYZ, a full-service digital media and marketing group specializing in more creativity, ideas, and fun for action sports marketing, sportswear marketing, sports product marketing, active lifestyle consumer products, health product marketing, and brands in San Diego and Southern California.