Did you know? ACA health insurance penalties are over. While there will no longer be a financial penalty for not having insurance coverage, the biggest penalty that still exists, is the risk of facing expensive medical bills in the event of an illness, an accident, an age-related condition or even preventative assessments. Simply put, this is why it pays to be insured.
Benefit of being insured
The biggest benefit of having health insurance is obviously the peace of mind that comes from knowing that you and your family are protected from the financial implications of unexpected medical events. With that being said, it’s always the right time to get covered.
80% of US citizens who enroll in the ACA (Affordable Care Act) receive premium tax relief or other Federal or State subsidies. Many, who are entitled to Medicare or Medicaid receive their care free of charge.
You are not eligible for these subsidies unless you enroll through a Government, State or Private Health Insurance Exchange. So what’s next?
Check with your chosen Exchange. Check with at least one more. It may cost less than you think to have the coverage you need, or even better, you may find better coverage within your budget.
Insuring for the first time?
If you were previously a dependent, covered by a parents plan, a student health plan, or you were covered through your workplace, these are just some of the reasons you may not have personally engaged with the ACA for the first time.
No exemption or qualifying health coverage?
Worried by gaps in your insurance history? If you did not have an exemption or qualifying health coverage (AKA Minimum Essential Coverage) for any period between March 31st 2014 and December 2018 you may be liable for retrospective payment of the fee known as the Shared Responsibility Payment.
The Shared Responsibility Payment (also known as a ‘penalty’)
Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the Shared Responsibility Payment fee no longer applies. This penalty is payable for any period for which you did not have MEC between 2014 through 2018. For example, the Shared Responsibility Payment over the period has been around $700 per adult ($350 per child), and a maximum of $2100 per household or 2.5% of household income, whichever is the higher. The reference point has traditionally been the cost of a bronze health insurance coverage plan.
If you didn’t meet the Minimum Essential Coverage
For impartial and informed advice contact a health insurance exchange. Remember you have a choice between the government and private health insurance exchanges.
Some examples of qualifying health coverage which might apply to your circumstances are as follows:
- Any health plan bought through the Health Insurance Marketplace. Individual health plans bought outside the Health Insurance marketplace, (off exchange) but only if they meet the standards for qualified health plans
- Any “grandfathered” individual insurance plan you’ve had since March 23, 2010, or earlier. These are approved plans which pre-date the introduction of ACA
- Any job-based plan, (employer sponsored) including retiree plans and COBRA coverage
- Medicare Part A or Part C (but Part B coverage by itself doesn’t qualify)
- Most Medicaid coverage, except for limited coverage plans
- The Children’s Health Insurance Program (CHIP)
- Coverage under a parent’s plan
- Most student health plans (check with your school to see if the plan counts as qualifying health coverage)
- Health coverage for Peace Corps volunteers
- Certain types of veteran’s health coverage through the Department of Veterans Affairs
- Most TRICARE plans (these apply mainly to the uniformed services and their dependent
- Department of Defence Non appropriated Fund Health Benefits Program
- Refugee Medical Assistance
- State high-risk pools for plan or policy years that started on or before December 31, 2014 (check with your high-risk pool plan to see if it counts as qualifying health coverage)
As you can see this is an extensive list but it is most important to individuals applying for health insurance coverage for the first time, or with a broken history of insurance that meets the MEC (Minimum Essential coverage).
TrueCoverage is here to help!
If you think you may have had lapses of coverage between 2014 thru 2018, contact Healthcare.gov or your state exchange. You may prefer to contact a Private Health Exchange such as TrueCoverage, who can give you advice based on your individual circumstances in the strictest confidence.
Talk to one of our trained Navigators. We’ll be happy to help you through the maze!