It’s almost Halloween, and you know what that means.
No, it’s not time to buy some candy and swill another pumpkin spice latte.
Better than that, it’s insurance season! Come Sunday, you’ll be able to shop 2016 health plans online and through local insurance brokers.
Before you go back to your bags of fun-size Snickers and your sugary coffee, stick with us for just a minute, because ignoring us could cost you: If you don’t have health coverage, you could face a noncoverage tax of 2.5 percent of your household income or $695, whichever is higher. Uncovered families will see a maximum penalty of $2,085.
If you’re insured through work, you’re probably set. Most employer-based plans offer the minimum benefits required under the Affordable Care Act.
No employer-sponsored coverage? No problem — Nevada’s individual insurance market has dozens of plans, including federally subsidized policies that give you a tax credit to cover your premium. Subsidy eligibility will depend in part on your age and plan, but in general, you qualify if you make between 133 percent and 400 percent of the federal poverty wage. At the low end, that’s $15,521 for a household of one and $31,721 for a family of four. At the high end, that’s 46,680 for a single-person household and $95,400 for a family of four.
If your income falls below $15,521 to $31,721, you may be eligible for Medicaid, which provides coverage for free.
You can avoid that federal penalty as long as you have a plan by Jan. 31.
The upcoming enrollment session will be the third sign-up period under the Affordable Care Act.
Some things will look different from past periods.
“A lot of the plans have just totally changed,” said Brent Leavitt, an insurance broker and Certified Financial Planner with Nevada Benefits in Las Vegas. “They have different copays and different deductibles. Some of them are more generous, but some of them are more stingy. You can’t expect things to just roll over. Be cognizant that your new plan may not be 100 percent what you had.”
You’ll also see a change in insurers selling through Nevada Health Link.
Two carriers have left the marketplace. Assurant announced in June that it would shutter its nationwide individual insurance division after it couldn’t find a buyer for the segment.
And Nevada Health CO-OP, a Las Vegas nonprofit created to provide competition on the exchange, will close Jan. 1 due to high claims costs and limited forecasts for enrollment growth.
At the same time, Reno-based Prominence will offer its first-ever Southern Nevada plans.
Prominence joins industry giants UnitedHealth Group and Anthem Blue Cross Blue Shield on the exchange. Prominence and UnitedHealth will sell HMO plans, while Anthem will offer both HMO and PPO coverage.
You’ll have more choice off of the exchange, so if you don’t qualify for a federal subsidy, there’s no point for you to buy through the marketplace, Leavitt said. Eighteen carriers are selling coverage outside the exchange. There’s little to no difference in level of benefits available on or off the exchange, because the Affordable Care Act requires all plans to offer the same essential health coverage.
Out-of-network coverage may be one other reason to kick tires outside the exchange. HealthPocket.com, a California-based website that compares and ranks insurance plans, released an Oct. 7 report giving Nevada poor marks for access outside of networks. Just 14.6 percent of the state’s exchange-based plans covered out-of-network medical bills. That was the third-worst share in the nation, after South Dakota (zero percent) and New Jersey (10.2 percent).
Unlike enrollment a year ago, Nevada Health Link doesn’t need to switch to a new sign-up platform. The exchange will borrow the federal healthcare.gov system for a second straight year.
The agency plans to boost its call center from six people to 10 to handle calls from consumers who have questions during enrollment, said spokeswoman Janel Davis.
Also, as long as income is steady, premiums will stay relatively unchanged for subsidized plans, Leavitt said. Premiums on the exchange will rise an average of 8.7 percent, but federal tax credits should also increase to cancel out most of the gain, he said.
Premiums for off-exchange coverage will be up 9.6 percent on average.
Leavitt added that he expects the number of sign-ups to be “about the same” the 2014 session, when his firm enrolled roughly 500 people through the exchange. About 70,000 signed up statewide for exchange-based coverage for the 2015 plan year.
“Hopefully, it’ll be pretty routine,” Leavitt said. “If people know what they’re going to buy, the renewal process takes only five minutes or so.”
Nevada Health Link plans a Sunday enrollment health fair to kick off sign-up season. The event, which runs from 10 a.m. to 6 p.m. at the College of Southern Nevada’s campus at 6375 W. Charleston Blvd., will feature insurance brokers and enrollment assistants to walk consumers through eligibility and application. Attendees learn about what kind of federal tax credit they can receive to help pay premiums.
The exchange also plans a number of sign-up and pop-up events through the enrollment period. It’s set to launch a barrage of fliers, mailers and ads to get the word out, Davis said.
“We’re really getting out there to get the word out and keep our enrollment number the same or even higher,” she said.
Consumers who want additional face time with an insurance professional will still be able to work with licensed brokers. Nevada Health Link has a broker search tool on its website that lets consumers find help in their ZIP code.
Contact Jennifer Robison at email@example.com. Find @_JRobison on Twitter.The 2016 enrollment session runs from Sunday through Jan. 31, and shoppers can look for Nevada-based plans through either nevadahealthlink.com or healthcare.gov.
But that federal noncoverage tax isn’t absolute. Some consumers can avoid it. You don’t have to pay if:
— The lowest-priced plan available to you through work or the individual marketplace costs more than 8.05 percent of your household income.
— Your income is so low that you don’t have to file a federal tax return.
— You weren’t uninsured for more than two months in a year.
— You’re eligible for services through an Indian Health Services provider.
— You’re in jail or prison.
— You experienced hardship. Qualifying hardships include homelessness; home foreclosure, eviction or bankruptcy in the last six months; a shutoff notice from a utility; domestic violence; the death of a close family member; or medical expenses in the last two years that resulted in substantial debt.
For additional exemptions, visit https://www.healthcare.gov/fees-exemptions/exemptions-from-the-fee/.