December 9, 2016
Insurance Superintendent Eric Cioppa is reminding Maine residents who want to have new health insurance coverage in place on January 1 of the upcoming December 15 deadline.
Open Enrollment for individuals to purchase, renew, or change plans for 2017 on the Individual Health Insurance Market will continue through January 31, 2017, but for a plan to be in place and provide coverage by January 1, 2017, it needs to be purchased by December 15, 2016.
Anthem, Harvard Pilgrim Health Care and Maine Community Health Options again have plans for sale for individuals and families both on and off the Healthcare Marketplace (at www.heatlhcare.gov) and Aetna is offering plans off the Marketplace.
For those currently without coverage, the annual Open Enrollment period is the only time to purchase health insurance without a special circumstance such as job loss, marriage or divorce, birth or adoption, etc.
Federal tax credits are available to qualified individuals and families who purchase plans through the Healthcare Marketplace. These credits are used to offset the cost of health insurance premiums to make coverage more affordable. Additional assistance with cost-sharing (deductibles, copays, and co-insurance) is available to those who qualify and purchase a silver plan.
Federal tax penalties will be applied at tax time for individuals and families who do not have a plan with “Minimal Essential Health Coverage” and do not qualify for a “hardship exemption.”
For those who currently have an individual or family plan, taking the time to look at what is being offered for 2017 could save money, provide a more satisfactory provider network, or better benefits.
“Those individuals and families who purchased a plan for 2016 will have their plan automatically renewed for 2017, if they are making payments as agreed,” Superintendent Cioppa said. “However, we encourage everyone, even those with existing coverage, to review their options.”
Small employers with fewer than 50 employees can purchase small group insurance once a year during the open enrollment period that runs November 15 to December 15 without meeting the participation levels required during the rest of the year. For more information about small group options in Maine, visit www.maine.gov/insurance, contact a broker or agent, or call the Bureau. For information about purchasing coverage through the SHOP Marketplace visit www.healthcare.gov/smallbusiness.
Individual tax credits are not available through SHOP, but tax credits are available to qualifying employers with fewer than 25 full-time equivalent employees making less than $50,000 on average.
The Bureau’s Consumer Health Care Division is available to answer questions 8 a.m. – 5 p.m. Monday through Friday. Contact the division at 1-800-300-5000 or 207-624-8475 (TTY use Maine Relay 711), or at Insurance.PFR@maine.gov.
TIPS FOR INDIVIDUALS AND FAMILIES
• The earliest that coverage will start is January 1, 2017.
• To have coverage on January 1, individuals must purchase a plan by December 15.
• Individuals who qualify for a tax credit will only have the credit applied if they purchase the insurance through the Marketplace.
• Tax credits do not apply to plans available for purchase outside the Marketplace.
• A tax penalty of $695 per adult up to $2,085 per family, or 2.5% of household income will be assessed at tax time for those without “Minimal Essential Health Coverage,” unless the individual or family qualifies for a “hardship exemption.” (Penalties for uncovered children under age 18 are half of the penalty amount for an uncovered adult.) Those Renewing Their Plans:
• Policyholders should carefully review the information from their insurance company to make sure the plan still meets their needs.
• Individuals who purchased a plan through the Marketplace may see an adjustment to their tax credit, due to a change in the second lowest silver plan, on which all subsidy, or tax credit calculations are based. This could result in a rate increase for some policyholders.
• Some individuals and families may be re-enrolled in slightly different plans due to their existing plan being discontinued. These policyholders also have the same option to purchase a different plan of their choice.
• For those who purchased plans on the Marketplace and have had changes to income and/or household size, it is very important to report those changes at www.healthcare.gov to have the correct premium tax credit applied and avoid owing money at tax time.
Important Points for Those Newly Enrolling or Renewing: Whether purchasing a new plan or re-enrolling in existing coverage, it is a very good idea to:
• Review the provider network to ensure that the health care providers and hospital one intends to use are part of the network, and confirm that the prescriptions one uses are covered. Individuals having questions about these issues should contact the insurance company.
• Use the rate calculator on the Bureau of Insurance website – www.maine.gov/insurance. It will provide the premium estimate for all plans in an individual’s geographic area in Maine, based on age and smoking status. The rate calculator does not factor in tax credits that may apply when purchasing a plan through the Marketplace (www.healthcare.com will calculate both).
• Seek assistance when needed – from an insurance company, an insurance broker or agent, a Marketplace Navigator (find one at www.enroll207.com), or the Bureau of Insurance.
The Maine Bureau of Insurance is part of the Department of Professional and Financial Regulation (www.maine.gov/pfr), which encourages sound business practices through high quality, impartial and efficient oversight of insurers, financial institutions, creditors, investment providers, and numerous professions and occupations.
Last Updated: December 10, 2016 11:09 PM