The Most Important Changes – Health Insurance in 2015

The Affordable Care Act had made insurance a constantly changing thing. I’m constantly asked, “What do I need to know for today?” So here is an update on a few of the most important changes for health insurance in 2015. This isn’t a comprehensive list but it will apply to the majority of our clients.


  1. Nevada is switching to the Federal Exchange. If you signed up through Nevada Health Link you will be asked to re-sign up on the federal hub. For clients who used a broker like Health Benefits Associates to sign up, we will help! It will be important to make sure we have the most current information for you.
  2. Keep an eye out for Qualified Life Events. Even if you have insurance through a company or through a spouses company, things change. This is by far one of the most important changes for health insurance in 2015. If you were to loose coverage for a situation outside of your control, most of the time you only have 30 days to get signed up for new coverage. If you miss the 30 day window for Qualified Life Events, you need to wait out a waiting period. In Nevada, it’s “First of the month following 90 days”. This is unrealistic for most people. If you were to enroll on September 3rd, without a Qualified Life Event, your plan wouldn’t start coverage until January 1st of the following year. If you DID have a Qualified Life Event, your plan would start the following month on October 1st.
  3. Tax penalties are increasing for individuals who decide to not have health insurance coverage. For tax year 2014, the fine for not having health insurance coverage was $95/adult + $47.50/child or 1% of your family income, whichever was greater, with a cap at $285 (Excluding exemptions for the individual responsibility requirement). This next year the fine is 2% or $325/adult + $162.50/child, whichever is greater, with a cap at $975. In 2014, we were asked several times, “What’s cheaper, buying insurance or paying the fine?” and we would tell clients, “If you NEVER get hurt or go to the hospital, paying the fine will be cheaper. In 2015 this will be answered the opposite way. It will most likely be cheaper to get a subsidized plan than to pay the fine.

For Groups / Businesses

  1. The Employer Fine still does not apply to businesses with less than 50 FTE’s (Full-Time Equivalents). Groups with over 50 FTE’s are usually very misinformed about their coverage options for the upcoming year. Most large employers who we have spoken with think they need to provide coverage. The truth is they just need to offer it with an “affordable” rate. They also believe because they have more than 50 people reporting for work that day, they are a large employer… This isn’t always necessarily the case. There are more important changes for small employers but they’re too numerous to list here.
  2. Buying group health insurance is still the only way to pay insurance premiums pre-tax. Almost all business owners don’t qualify for the Advanced Premium Tax Credit. For them, the biggest cost savings they’re going to find is still going to be through small business health insurance plans. No one can get both. It’s either using an APTC, or pre-taxing the health insurance premium. Many Administrative Services Organization (ASO) have been trying to find a loophole. They’re attempting to pre-tax an individual health insurance plan purchased through the exchange. There is no legal way to do it and the IRS is quickly answering any ambiguous terms they might have left open.
  3. Many insurance companies have re-filed rates for 4th quarter renewal rates. 90% of our groups took a “early renewal” option last year and elected to renew their plan with a November or December effective date. The goal was to keep their 2013 rate as long as possible in to 2014. 2014 was the first year of full ACA compliance for small businesses. These businesses annual renewal date is coming up this November and December. Many health insurance companies have decided their catastrophic rate predictions were a bit overstated. This is one of the most important changes for health insurance in 2015 and beyond. Insurance companies have re-tooled with lower rates for November and December. This is good news for everyone.