January 31 was the last day to enroll in a health plan for 2016

Uninsured? Want a different health plan? January 31 is the enrollment deadline

January 31 is the deadline to enroll in individual health insurance, on or off-exchange
Uninsured? Want to switch to a different health plan? January 31 is the deadline to enroll or make changes. Peter Cade/Creative RM/Getty Images

Today's the deadline to enroll in an individual health insurance plan. This is true in every state, although the state-run exchanges in Maryland and California have said they'll give enrollees a few extra days (until February 5th and 6th, respectively) to finish their enrollments, as long as they start the process by midnight on January 31.

Healthcare.gov has also said they'll work with people to finish up enrollments that are started by midnight on January 31, but they've repeatedly said that they will not issue a blanket extension applicable to people who don't begin the enrollment process by January 31.

This is a change from the last two years when enrollees were given additional time to start the enrollment process after the official deadline had passed.

Penalty going up sharply in 2016

If you're uninsured in 2016 and not eligible for an exemption from the ACA's requirement that everyone maintain health insurance coverage, you'll have to pay a penalty when you file your 2016 tax return next year. 

The penalty is going to be significantly higher than it was in 2014 and 2015. For those who are uninsured in 2016, the penalty will be the greater of $695 per uninsured adult (half that amount per child), up to a maximum of $2,085 per household, OR 2.5% of household income above the tax filing threshold.

For the average tax filer who ends up paying the penalty for 2016, it's expected to total almost $1,000. That's five times as high as the average penalty was in 2014.

Subsidies make coverage affordable

So if you don't have health insurance, now's the time to act.

And you only have a few hours left. If your household income doesn't exceed 400% of the poverty level, you may be eligible for premium subsidies if you shop in the exchange in your state (note that the vast majority of exchange enrollees over the past two years have qualified for subsidies, and the subsidies have significantly reduced the amount people have to pay for their coverage).

But there's also a lower income threshold for subsidy eligibility, and it varies depending on whether your state has expanded Medicaid. Medicaid expansion was supposed to be enacted nationwide under the Affordable Care Act (ACA), but the Supreme Court ruled in 2012 that states could opt out of expansion and keep their existing eligibility guidelines (which generally don't allow non-disabled adults without dependent children to enroll in Medicaid regardless of how low their income is).

As of early 2016, 19 states still have not expanded Medicaid (Louisiana is among the states that have expanded Medicaid, but coverage won't take effect until the middle of 2016). The lower income limit for premium subsidy eligibility in the exchanges depends on whether your state has expanded Medicaid:

  • In states that have NOT expanded Medicaid, eligibility for premium subsidies in the exchanges starts at 100% of the poverty level and extends up to 400% of the poverty level (for a single individual, this is from $11,770 to $47,080; for a family of four, it's from $24,250 to $97,000).
  • In the states that HAVE expanded Medicaid, eligibility for premium subsidies in the exchanges starts at 138% of the poverty level (where Medicaid eligibility ends) and extends to 400% of the poverty level (for a single individual, this is from $16,242 to $47,080; for a family of four, it's from $33,465 to $97,000).

Medicaid enrollment is year-round

If you're eligible for Medicaid, you can enroll anytime during the year. But the sooner you enroll, the sooner you have access to healthcare.

If you're in a state that hasn't expanded Medicaid, your eligibility for Medicaid will depend not only on income, but also on other factors such as whether or not you have a disability, and whether or not you have dependent children.

Unfortunately, there are almost three million people in 18 states who are in the coverage gap because their states haven't expanded Medicaid; they don't qualify for Medicaid, and their incomes are too low to qualify for subsidies in the exchange. For people in this situation, there's a special enrollment period that applies if their income increases later in the year (to at least 100% of the poverty level) and makes them eligible for a premium subsidy.

Native Americans can enroll year-round

In the exchanges nationwide, Native Americans and Alaska Natives have access to enrollment year-round. They also have access to plans with zero cost-sharing if their household incomes don't exceed 300% of the poverty level ($60,270 for a family of three).

So the January 31 deadline doesn't apply to Native Americans and Alaska Natives. But even still, it's far easier to deal with the health insurance enrollment process when you're healthy, as opposed to waiting until you're facing a health crisis. And it's also important to note that regular effective date guidelines apply throughout the year for Native Americans and Alaska Natives. In most states, that means enrollments have to be completed by the 15th of the month to have coverage effective the first of the following month. If a Native American/Alaska Native enrolls in a plan on June 20, her coverage wouldn't be effective until August 1.

So just as people eligible for Medicaid shouldn't delay their enrollments, neither should Native Americans and Alaska Natives. But the year-round enrollment available to Native Americans and Alaska Natives means that they can change to a different plan mid-year if they decide the coverage they originally picked isn't meeting their needs.

Off-exchange enrollment deadline is also January 31

Regardless of whether you're enrolling through the exchange or directly through a health insurance carrier, the January 31 deadline to get coverage for 2016 applies throughout the entire individual market.

Nevada is an exception: In Nevada, off-exchange enrollment continues year-round, but health insurance carriers can impose a 90 day waiting period before coverage becomes effective (to discourage people from waiting until they're sick to sign up for health insurance).

But in the rest of the country, open enrollment will end at the end of the day on January 31, regardless of whether the plan is sold through the exchange or not.

And keep in mind that subsidies are only available if you get your plan through the exchange. If you shop outside the exchange and then later in the year you experience a drop in income that would make you eligible for a subsidy, you won't be able to switch to an exchange plan at that point unless you have a qualifying event (a drop in income or loss of a job IS NOT a qualifying event). If you think that there's any chance you might qualify for a subsidy (either throughout the year or claimed on your tax return next spring), make sure you enroll through the exchange.

Qualifying events

After January 31, coverage will only be available for sale for 2016 if you experience a qualifying event. And HHS has said they will be tightening up enforcement of qualifying event rules in 2016, in order to verify that people submitting enrollments outside of open enrollment do indeed have a valid qualifying event.

In short, there will be limited opportunities to enroll in coverage for 2016 if you don't enroll by the end of the day today. The next open enrollment won't start until the fall, for coverage effective January 2017.

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