What Open Enrollment season runs between November 1 and January 15?
a. The ACA (Affordable Care Act)
b. The Marketplace
c. Obamacare
d. All of the above
Choosing “D” is correct! The Federally Facilitated Marketplace, originally dubbed Obamacare, but also known as the Affordable Care Act, features an Open Enrollment period annually between November 1 and January 15. Here are some questions heard every Fall:
Who can enroll in the Marketplace? Anyone who does not qualify for Medicaid, Medicare, or does not have access to affordable employer-based coverage.
I’m planning to retire in March, do I need to enroll in a plan now? No. Whenever someone leaves an employer-sponsored plan to retire or start a new job that doesn’t offer coverage, they will have a Special Enrollment Period to choose a plan on the Marketplace at any point during the year.
My COBRA is really expensive, can I switch to Marketplace coverage now? Yes. This is when you are able to voluntarily leave your current COBRA plan by choice and begin what is often a more affordable plan option for January 1 or February 1.
My employer covers the premium for my plan but not for my spouse and dependents. Can any of us enroll in MP coverage? Yes. However, there is an Affordability Test that determines eligibility to receive the Advance Premium Tax Credit to offset the monthly premium expense. In 2025, if the employee’s premium, or the premium to insure a spouse and dependents exceeds 9.02% of the gross household income, then it is considered unaffordable and either the employee and/or the spouse and dependents would be eligible to receive the tax credit.
Will I be penalized for not having health insurance? In 2019 the penalty for not having coverage was eliminated. In 2023 the fixed income limits to qualify for a tax credit were expanded to align with the Affordability Test. The more income a household has, the less tax credit they are eligible to receive. The tax credit is later reconciled on the tax return for the year the household had MP coverage.
MUST I renew my plan every year? Technically, no. However, every year insurance companies sunset any number of plans so you may be assigned a new plan that may not provide you with the benefits or network access you wanted. There could also be new plans with better coverage or benefits and lower premiums available. We advise updating your application annually to ensure you have the plan that best suits your needs.
For answers to your questions about the Marketplace or help with your enrollment, contact a licensed insurance agent at On Point Insurance Agency (insuranceonpoint.com). We are here to help!