Open Enrollment for healthcare coverage in 2016 (“Obamacare”) is kicking off November 1. This means that if you do not have insurance or want to change your insurance plans, you can do so between then and January 31, 2016. Your new coverage will start as soon as January 1, 2016 if you sign up by December 15, 2015.
Missing this period could mean missing healthcare coverage from the Marketplace in 2016! If you do not have insurance coverage, you may have to pay a fee. This isn’t a significant change from 2015, but the 2016 fee is significantly higher for some individuals.
Benefits of Healthcare Coverage
Getting health insurance is important. Having it is much more important than where you get it—whether it is from the Marketplace, through work, through programs like Medicaid, or through a private provider. Regardless of how you feel about the political aspects of the new healthcare laws, having insurance generally does provide a number of benefits.
- Health insurance is there for you if sickness or injury occurs when you least expect it.
- Health insurance can decrease sometimes staggeringly high medical costs.
- You can get free preventative care with qualifying plans—including screenings, check-ups, and vaccines.
- If you have a Marketplace plan or other qualifying coverage, then you can avoid the penalty fees associated with not having insurance.
Those with health insurance are also much more likely to visit the hospital or other care center. This not only helps you or your loved ones get better faster, it is also better for the whole community because it is less likely that you will spread illnesses to other people.
What Does It Mean to Have a Qualifying Plan?
All of the qualifying plans under Obamacare must include the following services:
- Ambulatory patient services and other emergency services
- Hospitalization (including surgery and overnight stays)
- Pregnancy, maternity, and newborn care (before and after birth), including breastfeeding coverage
- Prescription drugs, including birth control
- Rehabilitative and habilitative services (to help you gain or recover mental and physical skills after an accident, injury, or while recovering from most other health conditions)
- Laboratory services
- Preventative and wellness services, including those services to help manage chronic diseases
- Pediatric services (also including oral and vision care for children)
Some plans may also offer dental and vision for adults, but this is not a requirement for each plan on the Marketplace.
What is the Marketplace? Is It Something Everyone Can Use?
The Marketplace is a website where potential health insurance buyers can shop for healthcare coverage. They can compare prices and coverage benefits right on the page. All of the plans listed in the Marketplace will allow you to avoid the penalties and fees imposed for not having a qualifying health insurance plan. You can apply for coverage right from the website, but you can also call, visit with an in-person representative, or apply using a paper application process.
The Marketplace is for those who do not already have health insurance. Generally speaking, those who already get health insurance through their employer, Medicare, Medicaid or CHIP (Children’s Health Insurance Program), do not need to visit the Marketplace. If you lose coverage from any of these sources, however, you should head to the Marketplace to get coverage. If your employer’s insurance plan is unreasonably expensive, you may also be able to purchase coverage from the Marketplace.
One of the most appealing features of the Marketplace is that your coverage costs will vary depending on your income. Many applicants will qualify for a tax credit that will help them pay for their Marketplace coverage. Other savings through deductibles or copays may also be available to some applicants, depending on their income.
Part of your preparation for 2016 should be to ensure that you and your loved ones have health insurance that meets minimum legal requirements. All of the Marketplace plans do this, and most health insurance plans offered today have made the switch to meet these minimum requirements.
If you are already on a plan, you may see changes in your coverage in the next few years as even those plans that are “grandfathered in” make changes to adjust to the new federal and state healthcare laws. Prepare now for a happy and healthy 2016!