Obamacare Open Enrollment: 3 Must-Know Facts for Year 2

Hispanic female doctor examining patient

Open enrollment for health insurance through the Patient Protection and Affordable Care Act runs from Nov. 15 through Feb. 15. Here are a few things you need to know to make sure you get the best deal that's available to you.

1. You're Not Stuck With Your Initial Plan

Those who are satisfied with the current coverage typically don't need to do anything to keep that coverage, as their insurance company will automatically renew their policies if they don't hear differently. But under certain circumstances, it makes a lot of sense to look at other options.

  • If your health has changed dramatically, then it might make sense to look at more comprehensive insurance plans. You'll pay more in up-front premiums for higher-quality plans, but your out-of-pocket costs will typically be lower. You'll have to run your own numbers to figure out which way leaves you ahead.

  • Even if nothing has changed with you, you need to make sure that your plan didn't change. In some cases, you'll notice higher copayments and deductibles or more restrictive health-provider network choices that no longer fit your needs.

2. Penalties for Not Having Coverage Will Go Up in 2015

The Act's cost structure was designed around the idea that it would get as many people as possible covered by health insurance, and paying for coverage. The bigger the pool of insured, the better it works for everyone. So the law penalizes those people who don't buy qualifying insurance. During 2014, that penalty was limited to the greater of 1 percent of your income above the Internal Revenue Service filing threshold, or $95 per adult plus $47.50 per child within the household, up to $285 for an entire family. That may have gotten some attention, but for many people, it wasn't enough to justify paying the costs involved in getting an health insurance.

For 2015, those penalties are on their way up. The percentage amount doubles to 2 percent of income over the filing threshold, and adults will have to pay $325 and kids $162.50, up to a family maximum of $975.

That larger amount still won't be enough to get everyone to enroll, and exemptions consider factors like income, financial condition and other hardships. Nevertheless, government officials expect to emphasize the penalty more during this open enrollment period to encourage more people to participate.

3. Consider Your Obamacare Subsidy in Your Total Cost

One of the most attractive elements of the health insurance exchanges under Obamacare is that the federal government subsidizes premiums depending on your income level. Yet because income can change from year to year, your insurance company might only tell you what your gross premium before subsidies is, and that could leave you thinking that your rates just went up by a huge amount, when they haven't really.

Subsidies are based on how your income compares to the federal poverty level. In general, the more you earn, the more you're expected to pay for your own coverage, and the less of a subsidy you'll receive. Caps for how much of your income you'll pay range from 2 percent for those making less than 133 percent of the federal poverty level to 9.5 percent for those earning up to 400 percent of the federal poverty level.

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