Column 94 - Special Enrollment Period Ends 4/30

Special Enrollment Period Ends 4/30

This is the last week to buy individual insurance under the "Informed of tax penalty" category.  This category was established in response to those who claim they did not know they would be charged a penalty until they prepared their tax returns for this year.  This special opportunity ends April 30.

Coverage can be purchased on the Exchange at Covered CA or off the Exchange directly through insurance carriers.  The primary reason to purchase insurance on the Exchange is the ability to qualify for APTC (Advanced Premium Tax Credit).  As the names states, you are eligible to receive a tax credit in advance.  A tax credit is different than a deduction, in that it can be applied to taxes owed or in this case applied directly to the premium due resulting in a lower premium.

If you are not eligible for a subsidy, it's probably easier to apply directly to the insurance company.  However, they have a bit more stringent rules.  For example Anthem requires the following of the insured:

  • Not be currently enrolled in a health care plan
  • Attest that they did not realize there was a tax penalty on Anthem's form.
  • In addition, individuals applying for coverage must write "I Did Not Know About the Tax Penalty" somewhere on the first page of the application, submit a completed and signed attestation form, and submit payment or select auto payment method.  
  •  Applications submitted without "I Did Not Know About the Tax Penalty" written on the first page or no Qualifying Event box checked will be returned. If the application is due to a "Normal" qualifying event - the Qualifying Event box must be checked because standard effective date rules would apply

Other Special Enrollment Periods will continue based on qualifying life events.  These include losing health coverage through a job, getting married or entering into a domestic partnership, having or adopting a child, changing where a person permanently lives or gaining citizenship. For a list of common types of qualifying events, or to estimate a subsidy you may check

People whose income is less than 400% of the Federal Poverty Level are eligible for the tax credit.  This amount is based on family size and Modified Adjusted Gross Income (MAGI). 

It's important to remember that plans are guaranteed issue and have no pre-existing condition limitations.  That means that the insurance company cannot deny coverage to a qualified individual and they cannot deny claims for a pre-existing condition. 

It's interesting to me that we continue to get calls from people who want to make changes to their individual coverage.  It's clear that many people do not understand that absent a qualifying event you simply cannot buy health insurance other than during open enrollment.

I am sure it will take time for people to understand that the system has changed. So if you want to make changes and don't have a qualifying event, mark your calendar.  The Open Enrollment period for 2016 coverage is November 1, 2015 to January 31, 2016. I think it is unlikely that we will see this "informed about tax penalty" period again.

If an individual qualifies for Medi-Cal, they can apply any time.  However I encourage anyone who thinks they may qualify to consider applying sooner rather than later.  The process can take some time.  In addition, it can take some time to get an appointment with a Medi-Cal approved provider, so you want to give yourself some lead time.