Ask An Expert

Health Insurance Enrollment Options for 2016

By Rene Girard – Hesed Insurance Solutions

Q: I need health insurance for myself/my family. I know a lot of changes have taken place so I’m wondering if you can help me?

A: I’m here to help. Let’s get up to date then explore a few options.

The Patient Protection and Affordable Care Act (PPACA), sometimes called the Affordable Care Act (ACA) or Obamacare, was signed into law in 2010 and was mostly upheld by the Supreme Court in 2012. Now every long term health insurance plan sold in the USA must be PPACA compliant by providing Minimum Essential Coverage – a host of health benefits including maternity and prescription coverage. So what does that mean for you? It depends on your particular circumstances.

 Changes to non-employer based plans for individuals and families only:

  • UNDERWRITING: You can no longer be denied coverage for preexisting conditions. Because health issues are a non-factor, this means applications are approved for just about everyone. Tobacco users will still pay more.
  • COST: Healthier people now pay more for coverage in order to offset the medical costs of those who are less healthy. Men no longer pay less than women. Rates vary by age, zip code, tobacco usage, and plan coverage.
  • PLANS: All new long term major medical plans are “Metallic”: Platinum, Gold, Silver and Bronze. Many PPO plans are being replaced by EPO or HMO plans in 2016. People under 30 or with hardship exemptions may purchase Catastrophic Plans which have the lowest monthly premiums with the highest annual deductibles.
  • AGE RANGE: Plans are available for ages 0-64. Dependent children can remain on their parent’s plan until their 26th birthday. From age 65 onward the Government offers Medicare insurance.
  • MEDICARE: The rules for Medicare recipients are not the same as those for the PPACA. Medicare makes its own changes each year. For 2016, Medicare Part B premiums and the annual Part B deductible are expected to increase up to 52%. Please see my Ask an Expert article from September/ October 2014 entitled “Understanding the Various Types of Medicare Insurance” on the CAP website (http://www.bit.ly/CAP-MedicareInfo).
  • MEDICAID: Medicaid is directly affected by the PPACA. Medicaid expansion for low income individuals was encouraged and expected by the federal government. Many states voluntarily expanded; however, as of this writing, the following states have not: AL, FL, GA, ID, KS, LA, ME, MS, MO, NE, NC, OK, SC, SD, TN, TX, UT, VA, WI, WY. The federal government encourages states to seek reimbursement – this could be from your estate after death, or a lien on your home while you’re alive. Be sure to consult with an experienced attorney before applying for Medicaid.
  • SUBSIDIES: Some health plans are subsidized by the Government and others are not. These subsidies for financial assistance are based upon total household income and number of household residents.Subsidized plans are “On” the Public Exchange. Think of an “exchange” as an online marketplace. Premiums/Prices are based upon projected income. If your income increases, you may be required to reimburse the government for subsidies received.  Non-subsidized plans are “Off” the Public Exchange as part of the Private Exchange. Premiums are the full responsibility of the  insured – just like it has been for decades. There are no IRS forms or income qualifications.

           Note: Hesed Insurance Solutions offers only off-exchange, non-subsidized plans.

  • ENROLLMENT: Healthcare.gov is the now infamous Government website where individuals are encouraged to enroll online. The website helps to determine if you may or may not qualify for Government subsidies to reduce your monthly premiums. Enrollment is possible over the phone, on other insurance websites, or with a paper application.
  • OPEN ENROLLMENT PERIOD: Individuals and families can no longer enroll anytime of the year because now there is an official Open Enrollment Period (OEP). The next OEP is from Nov. 1st 2015 to Jan 31st 2016. If you need coverage and miss this OEP, then you may be penalized.
  • PENALTIES: If a person does not have “minimum essential coverage” then there is an IRS penalty. For 2015: $325 per adult + $162.50 per child not to exceed $975 total, or the greater of 2% of annual household income. For 2016 $695 per adult + $347.50 per child not to exceed $2085 total, or the greater of 2.5% of annual household income. (The maximum penalty is the national average premium for a Bronze plan. If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you lacked coverage for no more than two continuous months of the year, there is no penalty.)
  • SPECIAL ENROLLMENT PERIODS: If you lose health coverage from an employer, you may qualify for a 60-day Special Enrollment Period (SEP). An SEP allows you to apply for new health insurance coverage if you missed the OEP. Other factors that may trigger an SEP include: marriage or divorce, gain or loss of a dependent, change of residence, change in disability status, loss of Medicaid eligibility, loss of COBRA, and more.
  • EXEMPTIONS: It is possible to be exempt from Obamacare for a number of reasons including: the minimum amount you must pay for health insurance is greater than 8% of your household income; your annual income is below the income tax return filing requirement; financial or domestic hardship; incarceration; not lawfully present in the U.S.; you are a member of an Indian tribe or a religious sect that opposes insurance benefits, or you are enrolled in a health care sharing ministry.



Christians can be exempt from Obamacare if they maintain health coverage through a health care sharing ministry such as Medi-Share or Samaritan Ministries. This is not insurance! This is a way for devout non-tobacco using Christians to share each other’s financial burdens. Monthly dues are used to pay immediate needs. Medi-Share administration receives monies and sends checks to qualifying members. Samaritan Ministries members send checks directly to other members. Both encourage writing notes and praying for other members. Significant qualifying needs are publicized in newsletters. Medi-Share negotiates on your behalf to lower the amount you owe. Samaritan Ministries makes participation easier and more affordable. There are quite a few similarities and differences between these two organizations that serve individuals, families, and groups. Unlike insurance, there are no guarantees that the amount of money you need to pay your bills will be there when you need it; however, with tens of thousands of committed believers as members, it is possible to receive all that you need and more.


Some companies offer short term health insurance plans that last from 1 to 12 months. Rates may be more affordable than regular long term health insurance, but the plans do not necessarily cover any preexisting conditions and do not count as creditable coverage to avoid the IRS penalties of Obamacare. Electronic enrollment is quick and easy any time of the year and coverage can sometimes start the next day.


We direct employers to a Christian agency partner. Employees need to revisit all options available through their employer before searching elsewhere. A change of employment in order to attain a more desirable income or improved healthcare benefits may also be worth serious consideration.

The preceding information is neither comprehensive nor complete. If you would like more information on any of these topics, please visit my website: InsureMyParts.com, where you can also compare non-subsidized health insurance plans and prices from some of the largest insurance companies in the nation (varies by state). This Self-Serve Insurance® website is safe and secure, allowing you to enroll online 24/7 from the comfort and convenience of home. There are also special links for the Health Care Sharing Ministries mentioned above. Both Hesed Insurance Solutions and CAP will benefit should you decide to enroll in any of the available plans at the same low prices as going direct.

 No access to the internet? Call my office: 1 (619) 730-HELP. No nationwide calling? My call center’s phone number: 1-800-9-800-342.

Whether you have regular insurance or decide to try a Health Care Sharing Ministry, make sure those you care about have coverage “just in case.”

 Mr. R. Girard has been selling insurance since 2004 and is now doing business as Hesed Insurance Solutions. By offering a wide variety of insurance and financial products to residents of all 50 states, Mr. Girard and his team are here to meet your needs with free consultations courtesy of CAP member benefits.


                                                     ENROLLMENT PERIODS AT A GLANCE

                                                    Annual Open Enrollment Period                         SEP

Under 65 Health                         Nov 1/2015 – Jan 31/2016                                                   Yes

Medicare Part C Advantage      Oct 15 – Dec 7                                                                      Yes

Medicare Part D                          Oct 15 – Dec 7                                                                        Yes

Medicare Supplement                None (Enroll/Switch when able)                                     No

Senior’s Choice                            None (Enroll anytime)                                                         No

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Having roadside assistance coverage is a good thing. It gives you peace of mind while you’re traveling and can be quite budget friendly when emergencies like flat tires and dead batteries surprise you.
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Some insurance companies take your calls for roadside assistance into consideration when determining your insurability, so whether your insurance company is reevaluating your premiums or you’re purchasing auto insurance from another carrier, you might find the agent is looking at your roadside assistance calls as he or she determines your coverage eligibility and premiums.
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Before making a decision, talk with your insurance agent about the cost of your company’s roadside assistance coverage, how using the coverage might affect your premiums, and whether the company takes your roadside assistance calls into consideration when determining your insurability. In the end, choosing to purchase roadside assistance from an automobile club rather than from your insurance company might better suit both your budget and service needs.

Article courtesy of Best Roadside Service.

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