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What to know about the March 31 PPACA deadline

(Associated Press photo/Jon Elswick)
(Associated Press photo/Jon Elswick)

After all the waiting and all the fuss, there’s now less than a week to go until Obamacare’s big deadline. March 31 is the last day to sign up for health care coverage under the Patient Protection and Affordable Care Act or face a penalty (or tax) under the law.

Here’s what to know about the deadline.

The delays

Though many aspects of the law have been killed, changed or delayed, the administration has insisted the March 31 deadline would not be moved.

However, for some Americans that doesn’t hold true.

On Wednesday, the administration announced it will grant extra time to consumers to complete commercial coverage applications in the states where it runs the public exchanges.

HHS officials said they aren’t officially changing the March 31 individual qualified health plan enrollment period for everyone, but they’ll make a special enrollment period available to consumers who start the individual plan application process by March 31 but failed to complete it.

Also this month, the Obama administration said enrollees in the federal Pre-Existing Condition Insurance Plan will have another month to stay there while they search for coverage. Sick patients on the temporary health plan now can buy an additional month of PCIP coverage through April 30.

The PCIP program was due to end on March 31, but the extension was granted amid concerns that some of the nation’s sickliest patients won’t be able to find and buy health coverage ahead of the deadline.

“As part of our continuing effort to help smooth consumers’ transition into Marketplace coverage, we are allowing those covered by PCIP additional time to shop for new coverage while they receive the ongoing care and treatment they need,” Centers for Medicare and Medicaid Services spokesman Aaron Albright said in a statement.

Enrollment isn’t completely over

Because of both the extensions, and other events, enrollment won’t be completely over on March 31.

The open enrollment system applies only to consumers buying individual qualified health plan coverage through an exchange. Consumers can get a “special enrollment period” after March 31 by showing that they have undergone a major life change, such as the loss of a job, or that they qualify for a hardship exemption from the usual open enrollment period rules.

Meanwhile, some brokers anticipate that the ‘special’ medical market could be a big one for them.

The penalties

Under PPACA, virtually all Americans must buy health insurance or pay a penalty.

Some Americans are exempt. These include those in prison, not legally in the United States, in a health care sharing ministry or recognized religious sect that objects to health insurance, members of a federally recognized Indian tribe, or if the cost of coverage would exceed 8 percent of a consumer’s household income. Consumers whose previous policy was canceled because of PPACA requirements are also exempt from the penalty for one year.

For the rest of us, the penalty this year is the greater of either $95 or up to 1 percent of the portion of the person’s modified adjusted gross income that exceeds $10,150, which is the level that requires you to file a tax return. That rises to $695, or 2.5 percent of income, by 2016.

However that simple $95 fine might be much more for some. For example, if a couple has two children, files taxes jointly and is uninsured, the penalty will be at least $285 in 2014.

The subsidies

Subsidies under the law are meant to make health care coverage under the law more affordable. Premium tax credits for 2014 plans were designed to lower premium costs for people with household incomes between 100 percent and 400 percent of the 2013 federal poverty level ($11,490 to $45,960 per year for an individual).

But subsidies are calculated using a complex formula based on the cost of a plan’s premium, and are only available when a baseline plan’s premium exceeds a specific percentage of an enrollee’s monthly income. This sometimes puts consumers who think they’ll get a subsidy into a “subsidy gap.”

HealthPocket said that in major cities, for example, some young people are falling into a “subsidy gap” where they’re unable to obtain government subsidies to help pay for their plans despite being eligible. HealthPocket looked at plans for young adults in eight major cities — Philadelphia, Miami, Los Angeles, Atlanta, Houston, Detroit, Chicago and Phoenix — and found that in every city, young adults under 35 couldn’t obtain premium subsidies for exchange plans within the complete income bracket specified by PPACA.

On average, the maximum income at which young adults could qualify for a premium subsidy was $31,744. That average is $14,216 below the highest subsidy-eligible income stipulated by the law.

See also: Appeals court hears PPACA exchange subsidy challenge

The numbers

As of mid-March, PPACA enrollment totaled more than 5 million, according to the administration.

Initially, the administration said it would have 7 million Americans enrolled under PPACA this year, but it has since backed away from that. The law’s slow start is often blamed by website problems that plagued HealthCare.gov for months, but a lack of awareness of also has hampered its success.

The Congressional Budget Office estimated 6 million people would enroll in exchanges in 2014, but consulting firm Avalere Health projected earlier this month that exchange enrollment is on track to reach 5.4 million by the end of March.

Health care experts say that enrolling millions of Americans is vital to the success of the law, though Avalere Health downplayed that notion, saying having healthier individuals enroll is more important.

“The administration is conducting aggressive outreach in March in an effort to boost enrollment,” said Caroline Pearson, vice president at Avalere. “However, success of exchanges in 2014 will depend less on the size of the market and more on the risk profile of enrollees.”

That may be the hope for the administration, as a Bankrate report found that that more than a third of uninsured Americans (34 percent) don’t plan on buying health insurance, despite the law’s requirement to do so.

Navigators will stick around

The team of some 30,000 exchange enrollment workers the administration has created won’t disappear April 1.

“In-person assisters, including navigators and certified application counselors, will continue many of their existing functions” after April 1, CMS officials wrote in a weekly newsletter.

The assisters will help consumers sign up for coverage, answer questions about using the new coverage, and educate them both about PPACA and about health insurance, officials wrote.

Officials said assisters also might help consumers appeal exchange or plan enrollment decisions, or decisions by plans to deny claims.

Plan costs

According to eHealth, health insurance on the individual market is much more expensive under PPACA.

In its analysis, the private exchange operator found that the national average premium for an individual health plan selected through eHealth without a subsidy was $271 per month, a 39 percent increase from the national average individual monthly premium for pre-PPACA coverage a year ago.

The most recent national average premium for family plans without a subsidy was $666 per month, a 56 percent increase over the national average family premium in February 2013, which was $426 per month.

Premiums are much higher, eHealth explains, because of beefed-up benefits in PPACA-compliant plans. The increase is also due in part to consumers choosing plans with fewer out-of-pocket costs.

Originally published on BenefitsPro. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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