If you don’t have health insurance and want it, now is the time to act. Despite an announcement Wednesday that certain consumers will have more time to sign up for a private health insurance plan under Obamacare, the official deadline is Monday.
Carve out plenty of time. The steps could take a while, especially in the last few days of open enrollment, when thousands of other consumers are expected to flood enrollment websites, state and federal hotlines and insurance company call centers.
Here are factors to consider before you begin the process:
Know the deadline. You have until March 31 to buy a private health plan that will take effect May 1.
If you miss the deadline, you won’t be eligible to buy insurance again until open enrollment returns Nov. 15, and that coverage won’t take effect until 2015.
People who started to apply for coverage on the HealthCare.gov website but are unable to finish by Monday will have additional time to seek an extension, the Obama administration said Wednesday.
To qualify for the extension, people would need to check a blue box on the federal website to indicate they tried to sign up before the deadline.
Beyond those extensions, there are other special circumstances under which you can buy a plan outside open enrollment. If you lose your job, for example, experience a death in the family, marry or divorce, move out of state or have a baby, you’ll be able to pick up a policy.
For low-income Illinoisans, there is no deadline: The state’s Medicaid program accepts applications year-round at abe.illinois.gov.
Beware of penalties. There are penalties for going without insurance. They would be part of your 2014 tax bill due about a year from now.
For 2014, adults will pay $95 each (plus $47.50 for each child who goes uninsured) or 1 percent of household income, whichever is greater.
A lot of people are surprised to learn they’ll pay much more than the often-cited $95, says Aaron Martinez, master tax adviser with H&R; Block.
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“Most people are going to pay 1 percent of their household income,” he said.
There are also caps on the penalties, and a growing list of so-called hardship exemptions for which you must apply to avoid paying the tax.
If looming deadlines and the threat of penalties have suddenly persuaded you to buy insurance, here’s what experts say you should keep in mind:
Know what you’re entitled to. The health law makes subsidies available for individuals earning up to $46,680 per year and helps lower out-of-pocket expenses for those with incomes slightly below $29,000. Illinois also has expanded Medicaid eligibility to those earning less than about $15,500 per year.
Check for yourself before deciding insurance is too costly. Online calculators can help you figure out whether you are eligible for subsidies and how much. But don’t rely only on subsidy calculators to determine what you’re eligible for, said JoAnn Volk, senior research fellow with the Georgetown University Health Policy Institute.
You should start the application process on getcoveredillinois.gov to determine whether you or other family members may be eligible for Medicaid. If not, proceed to HealthCare.gov, the federal website that runs the health insurance marketplace for Illinois and 35 other states, to determine any subsidy.
Know what you’ll need to start the process. In a word: documents. You’ll need your Social Security number as well as anyone else’s in your family. You’ll need your employer information, income data and tax information contained on pay stubs, W-2 forms and tax returns.
Pick a plan. You’ll be able to select from four plan types — bronze, silver, gold and platinum — some with higher monthly costs that offer more coverage, others with lower monthly costs and less coverage. People younger than 30 can also choose a low-cost catastrophic policy, though in Illinois, most of those plans cost about the same as bronze plans.
Experts say you need to examine carefully the monthly cost of your plan and out-of-pocket expenses, such as deductibles, copays and co-insurance. If you want specific doctors, make sure they are in the network.
“A big problem with (HealthCare.gov) is that it doesn’t enable you to compare total plan costs — premium plus out of pocket,” said Robert Krughoff of healthplanratings.org, a free website launched in Illinois last month and run by the nonprofit Consumers’ Checkbook. “So people will make wrong assumptions that could cost them thousands of dollars.”
The vast majority of bronze plans in Illinois carry annual deductibles of at least $4,000 for an individual and $8,000 for family coverage that you must pay out of your own pocket before your insurer helps you with your medical bills.
You can shop on or off the exchange. If you qualify for a tax subsidy, you must buy your plan through HealthCare.gov to take advantage of it.
But if you earn too much to qualify for financial help, you can search beyond the health plans offered on the exchange to get a wider range of options.
In addition to individual insurers’ websites, you can try websites like gohealth.com or ehealth.com to compare and buy insurance. You can seek free guidance from one of the 1,600 paid navigators who got federal grant money to help walk consumers through the process, or an insurance agent. For a list of local navigators and independent agents, go to getcoveredillinois.gov/get-help.
What if you picked the wrong plan? If you haven’t paid your premium yet and your coverage hasn’t started, you’re able to switch to a different plan through HealthCare.gov. If you have paid the premium and the coverage has started, you can switch plans, with some caveats: You must remain with the same insurer and select a plan within the same level. Further, you can only switch to a plan with a larger network of doctors and hospitals. To make a change, call the insurance company directly.
Get help now: Illinois officials advise people still shopping for insurance to act now.
“We do not want everyone waiting until the last minute,” said Jennifer Koehler, executive director of Get Covered Illinois. Though people who started applications March 31 or earlier have been granted additional time to complete enrollment, it’s best to sign up and pay for your plan as soon as possible, experts said.
To find help with last-minute sign-ups:
In Illinois, the first place to start is getcoveredillinois.gov or call 866-311-1119. The call center is open 7 a.m. to 10 p.m. through Thursday, and 7 a.m. to midnight from Friday through Monday.
To find a trained navigator in your neighborhood and a list of outreach events, go to getcoveredillinois.gov/get-help.
For insurance agents certified to sell plans on and off the marketplaces (who, by the way, do not charge consumers a fee): nahu.org/consumer/findagent2.cfm.
For help with the Illinois insurance exchange, go to HealthCare.gov or call 800-318-2596 to speak with agents at the federal call center.
For a better sense of which plan you should choose for yourself or your family, go to healthplanratings.org, which offers consumers tools to compare plans and coverage.
Online brokers like ehealth.com and gohealth.com also offer useful comparison tools.
Lisa Zamosky writes for the Los Angeles Times.
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