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Obamacare: deadlines, misunderstandings and such

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Sign up sooner, rather than later

By Trina Ortega

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Sopris Sun Correspondent

If you missed the December deadline to buy health insurance under the Affordable Care Act, aka Obamacare, you can breathe a small sigh of relief. The open enrollment period to get coverage for 2014 continues through March.

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But local insurance brokers are advising individuals who still need to sort out their coverage or who need new plans altogether to sign up for a plan sooner versus later.

“Don’t wait till the last minute,” said April Trulove of Martin Insurance Group in Carbondale. “This is a yearlong decision; you don’t make a decision like this on the fly. You want to make sure you’re making the right decision for your needs.”

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Not to mention that if you qualify for a subsidy (which is in the form of a tax credit), you need to officially submit a Medicaid application, which can take up to 45 days to process. Prater further emphasized that individuals who wait to sign up for a plan may have a gap in coverage due to the normal time it takes for a plan to go into effect.

Martin Insurance Group co-principal Peter Martin explained: “In order to receive a subsidy or tax credit, you must be declined by Medicaid. That’s where the big bottleneck is in the whole process of the application. Selecting the insurance plan is actually the shortest part of the process.”

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Americans had until Dec. 27, 2013, (a deadline that was bumped two times) to sign up for health coverage that would begin on Jan. 1, 2014. If you did not meet that deadline, however, the sign-up period (referred to as the “open enrollment period”) to get coverage in 2014 is ongoing through March 31.

“This one is six months. They’re making this one intentionally long to give people time to adjust to the new policies,” Martin said. The enrollment period for 2015 will be only two months, beginning on Nov. 15, 2014.

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Shifting deadlines and the Medicaid application are only two facets of Obamacare  that have been tricky to keep straight.

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Martin says another misunderstanding is that people believe they can sign up for a health plan anytime in 2014.

“Once you’re outside of the March 31 time period, you’re not able to apply,” Martin said. “If you miss the deadline, unless you have what they’re calling a ‘qualifying life event,’ you can’t go buy individual health insurance. What a lot of people think is, ‘I’ll wait until I get more money, or when I’m ready to buy it.’ Some people think all insurance is guaranteed issue and some say they’ll wait till they get sick and need it. That’s not how it works. You’ve got to do it during this open enrollment period.”

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Individuals do have a three-month grace period — the clock is ticking right now! — to go without insurance. Although it’s not against the law to go without health insurance, if a person doesn’t have coverage he pays a penalty — $95 or 1 percent of your household income, whichever is greater, as reported on your tax return.

Trulove said if you’re still wading through the nitty gritty, trying to understand what direction to take, use a health insurance expert.

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“I think the biggest thing people need to understand is that — and I’m not saying this just for our agency but for every single agency — brokers do not cost any money, so why not use a broker that does this every day, that’s an expert, to assist you? It doesn’t cost you any money,” Trulove said.


And those for whom the act was written might have more affordable options under Obamacare and not know it. Martin’s team has been surprised to learn that more people in the Roaring Fork Valley than expected are qualifying for Medicaid under the adjusted state standard, which expands Medicaid to include those whose taxable income is under 400 percent of the federal poverty line.

In spring, the Colorado Institute of Health estimated that with an expansion of Medicaid, about one of six Coloradans between the ages of 19 and 64 would become eligible for Medicaid. The Kaiser Family Foundation has estimated that 59 percent of Coloradans will qualify for a subsidy under the expanded Medicaid thresholds.  

Here’s the example: A family of four reports that it makes $94,200 adjusted gross income. The most they would pay monthly for health insurance is 9.5 percent of that, or $747, for a “silver” (average) plan. That could be a decent savings for a family in a resort community such as Carbondale, where premiums are higher.

According to Martin, even if you’re just outside that “line,” it may be worth a second look since other factors (such as IRA investments) affect your adjusted gross income.  

“There’s a whole other ingredient to this which is the financial side of it,” Martin said. “We’re not worried about medically underwriting you anymore. We don’t care about your health history; you can’t be denied coverage. But we’ve got to navigate you through whether you qualify for subsidies or not. What we’re doing is we’re having more of a financial discussion now than a medical discussion.”

Colorado residents who qualify and want the subsidy/tax credit must shop the state exchange, Connect For Health Colorado (, to purchase health plans. Those who do not qualify for a tax credit may also shop the state exchange. But Martin stressed another misunderstanding — the plans on the state exchange are not the only options.

“There are plans you can buy that are not on the website. So if you go direct to the state, you’re only going to see half of the marketplace,” he said, noting that “off-exchange” plans are typically sold through a broker or directly via a carrier.