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By Carolyn Beach • October 19, 2017

Interested in Getting Involved with the ACA? Here's What You Need to Know!

Open Enrollment for the Affordable Care Act is right around the corner! If you are considering getting involved in this line of insurance, here are some great facts for you and your clients.


1. The open enrollment deadlines have changed:

  • Open enrollment starts Nov. 1, 2017, and continues through Dec. 15, 2017.
  • Coverage will start Jan. 1, 2018.
  • If your client misses the open enrollment, they will not be able to sign up for coverage unless they qualify for a special enrollment period.

2. People should sign up if they don't have health insurance from another source:

  • If your client does not have health insurance through their employer or their spouse's employer.
  • If your client is over 26 and no longer on parent’s insurance
  • They do not have a form of government coverage (Medicare, Medicaid or VA benefits)
  • If they qualify for tax credits to help you pay for health insurance coverage.

3. There are penalties for not having health insurance:

If a person went without health insurance in 2017, the penalty is 2.5 percent of 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. The maximum penalty is set at $2,085. For the 2018 tax year and beyond, the penalty will remain at 2.5 percent, but the flat and maximum amounts will adjust for inflation.

Under the Affordable Care Act, you must have health insurance or pay a penalty at tax time.

NOTE: People will still pay a penalty for being uninsured if you have only these types of plans:

  • Coverage only for vision care or dental care.
  • Workers compensation.
  • Insurance that covers only a specific disease or condition, such as cancer insurance.
  • Plans that offer only discounts on medical services.

4. All health plans must cover the 10 essential benefits to be exempt from the tax penalty:

  • Outpatient care including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

5. If a person suffered a hardship, they may not be required to buy health insurance:

  • Being uninsured for less than three months of the year.
  • They are the victim of domestic violence or suffered from a natural or human-caused disaster such as a fire or flood that damaged your property substantially.
  • A close family member recently died or had unexpected expenses related to caring for an elderly, ill or disabled family member.
  • If have been evicted from your home or suffered bankruptcy.
  • If the client found out they are ineligible for Medicaid because your state did not expand eligibility under Obamacare.
  • If they are not in the U.S. legally.
  • If they are incarcerated -- either detained or in jail.
  • They also are exempt if they are a member of a recognized religious sect that has religious objections to insurance.
  • Finally, they aren't required to have health insurance if they live abroad for more than 330 days out of the year.

With the ACA open enrollment period embarking upon us make sure that you have your FFM certifications complete and that you are ready to hit the ground running on day one. Please stay tuned for future ACA focused webinars hosted by Mike Smith, President of The Brokerage, Inc. As always, please let us know if you have any questions, and visit our website for up-to-date info! Happy selling!