Be Vigilant as More Health Insurance Changes Kick In

640px-Obama_signs_health_care-20100323November is a notable month. Not only do we have Thanksgiving, Black Friday and Cyber Monday, but we have the start of open enrollment in health insurance plans.

For years, open enrollment was a fairly routine exercise. Employees waited to see if their carriers would change and how much their out-of-pocket expenses would increase. However, as the Affordable Care Act has been increasingly implemented over the last couple of years, open enrollment has been delivering more than its usual share of surprises.

Small biz exchanges go live

This year marks the debut of the federal government’s “Small Business Health Options Program” or SHOP exchange. (I guess SBHOP didn’t seem catchy enough.) The federal government rolled the exchanges out early in five states for some live testing. Hopefully, they will avoid the debacle that last year’s exchange debut proved to be.

However, the SHOP exchanges are only for small businesses with 50 or more full-time employees. Employees at smaller businesses need to go to the individual exchanges. There’s one more major change this year that you and your employees need to know: the penalty for carrying no health insurance triples. The penalty for tax year 2015 will be 2 percent of a household’s income or $325, whichever is greater. There are some exemptions based on income.

Have employes in multiple states?

If your small business has employees in more than one state and you want to use the SHOP exchange to get health insurance, it may get tricky. That’s because some states operate their own exchanges. In that case, employers will have to create accounts in state exchanges. Further, plans, participation and eligibility vary from state to state.

How will this be sorted out? It could be that state and federal governments will use the same approach they used with the debut of exchanges last year – a combination of figuring it out as they go along, delaying some aspects of the ACA and exempting certain groups.

Double check your coverage

Let’s look at one more ACA ball that is up in the air for anyone who received health insurance through one of the exchanges last year: Don’t assume your coverage will continue. The federal exchange ( should be auto-renewing people, however some states do not offer auto-renewal.

In addition, everyone who signed up with Medicaid needs to reapply due to eligibility requirements. And finally, everyone who signed up online should revisit their plans and status. Even if your provider auto-renewed you, price changes might make you want to change plans.

These are just some of the bumps on the road that we believe are coming our way. There’s a good chance more unintended consequences will come to light as we’re shopping for our Thanksgiving turkey.

Stay tuned.

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Image: “Obama signs health care-20100323” by Pete Souza. Licensed under Creative Commons Attribution 2.0 via Wikimedia Commons.