Open enrollment for 2016 individual & family health plans

Nov. 1, 2015

Jan. 31, 2016

Under the Affordable Care Act — more commonly known as “Obamacare” — you can only sign up for health insurance during an annual open enrollment period, unless you have a “qualifying life event,” such as loss of employer coverage, getting married, getting divorced, moving out of area, having a baby, etc.Due to ACA, you must have health insurance or pay a penalty at tax time.

That annual open enrollment period is fast approaching!!

If you do not have coverage through your employer and you are buying health insurance on your own, here are some things you need to know.

1. Open enrollment starts Nov. 1, 2015, and continues through Jan. 31, 2016.  Your effective date depends on when you enroll.

  • If you sign up between Nov. 1, 2015, and Dec. 15, 2015, your coverage will start Jan. 1, 2016.
  • If you sign up between Dec. 16, 2015, and Jan. 15, 2016, your coverage will start Feb. 1, 2016.
  • If you sign up between Jan. 16 and Jan. 31, 2016, your coverage will start March 1, 2016.

This will be the last year open enrollment extends into January. Starting for 2017 health plans and beyond, open enrollment will be from Oct. 15 to Dec. 7 with Jan.1st effective dates.

2. If you don’t have health insurance from another source, open enrollment is the time to enroll in coverage.  It is also the time to make changes to your current plan.

If you signed up for health insurance during open enrollment in 2015, your plan will automatically renew. However, the plan may make changes to its premiums, provider network, copays, co-insurance, and drug coverage. Your insurance company will send you a notice of any changes it will make for 2016.  Open it. Read the mail, and see what it means for you!  Check to see if your provider network is still what you want and make sure that the doctors and hospitals that you prefer to use are in network.  Your prescription drug coverage could also change. The plan may no longer cover the drugs you take to manage your chronic conditions. It’s important that you check your plan’s drug benefits for 2016 before you allow it to renew. You may need to find a different plan for your needs and now’s the time to do it.

3. Penalties for not having health insurance have increased for 2016.

If you go without health insurance in 2016, the penalty is 2.5 percent of your income or $695 per adult (whichever is more) and the penalty for each child in the family without coverage will be up to $347.50. (In 2015, it was the greater of $325 or 2 percent of your income.).

4. You can buy coverage in Georgia on the Federal Marketplace or directly from a private insurance company.  If your family size and household income determines that you are eligible for tax credits, you would buy coverage on the Federal Marketplace.

You may qualify for a premium tax credit which is based on income and family size. To qualify, your family income must fall between 100 and 400 percent of the federal poverty level (FPL).

That means, for example, a family of four with an income between $24,250 and $97,000 in coverage year 2016 would qualify for these credits. If you qualify, the credits can be applied to your monthly insurance premiums. If your income changes during the year and you no longer qualify for the credits then you may have to repay the subsidy when you file your taxes.


The staff at Michelle Cole & Associates, Inc. is here to help you with your health insurance needs.  No matter what your family situation or income may be, we can help you find the right coverage for you and your family.  Call or email us for help!