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TONY WILSON: March 31 deadline for health insurance enrollment looms

Tony Wilson

Tony Wilson

If you haven’t enrolled for medical coverage, either through healthcare.gov or directly with an insurance carrier, you only have a few days left before the Affordable Care Act (ACA) open enrollment closes.

The deadline, unless the administration grants an extension, is March 31.

For individuals and families who apply by the deadline, your coverage will be effective on May 1.

If you miss the deadline, you will have to wait until the next open enrollment, which currently is scheduled for Nov. 15, 2014 to Jan. 15, 2015, unless you have a qualifying event.

For those with a qualifying event — such as loss of other coverage, marriage, divorce, death — you can enroll during the year as long as you do so within a timely manner. I recommend within 30 days from the date of the event.

You have the option of applying for an On Exchange plan or an Off Exchange plan.

We refer to plans offered through healthcare.gov as “On Exchange” plans, and typically the only reason to apply for an On Exchange plan is if you are eligible for a premium subsidy. In order to receive the subsidy, by law, you must be enrolled in an On Exchange plan.

While most people are taking the subsidy to help offset the monthly premium, you do have the option to take your subsidy in the form of a tax credit. The tax credit would be applied when you file your federal return for 2014.

Please note, if you take a subsidy and then later it’s determined you do not qualify for the subsidy, you will have to pay back that money. Tax time is the true-up time.

If you are eligible for coverage through your employer or a spouse’s employer that meets the ACA affordability and minimum value requirements, then you are not eligible for a subsidy.

A plan is considered affordable under the ACA if the portion you pay for employee-only coverage is less than 9.5 percent of your wages. (Even if you have dependent coverage the calculation is based on the employee-only cost and contribution.)

A plan meets the minimum value requirement if it pays at least 60 percent of the total cost of medical services. Most plans currently in place meet this requirement, but your employer can have the plan tested for confirmation.

If your employer does not offer a group plan, but your spouse’s employer does, then you apply the same affordability and minimum value standards to your spouse’s plan using him or her as the employee.

If coverage is not offered to you or your spouse or if a plan fails the affordability or minimum value requirements, then you could be eligible for a subsidy. The amount of the subsidy is based on the size of your household and your total household income.

A single person earning up to $45,960 should qualify for a subsidy while a family of four with a household income of up to $94,200 should qualify.

I encourage you to visit healthcare.gov to find out more information about qualifying for a subsidy, including who to report as part of your household count and what income to include.

If you are not eligible for a subsidy or you simply do not want to enroll through the marketplace, then you should consider an “Off Exchange” plan. An Off Exchange plan is simply a plan offered by an insurance carrier directly to consumers outside (or “off”) the Exchange.

You can apply for an Off Exchange plan directly at a carrier’s website, or through a local broker. The rates are the same, so I encourage you to use a local broker who commits to being there for you after the sale to provide assistance with billing issues, claims problems or any questions that may arise.

If you do qualify for a subsidy, you can apply for an On Exchange plan with the assistance of a navigator or local broker. You also have the option of applying online at www.healthcare.gov or by calling 800-318-2596.

Clients who are applying for Off Exchange plans are being approved and issued the same day.

For clients applying with healthcare.gov, it is taking a few weeks for those plans to be finalized and ID cards issued. The key with applying through healthcare.gov is to be patient.

Questions or comments? Feel free to email me at twilson@nfp.com.

Tony L. Wilson is a partner with NUVISION Financial Corporation based in Conyers. NUVISION is a subsidiary of National Financial Partners Corp. (NFP), which provides benefits solutions for companies.