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Health insurance: closed for business

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hospital-closed-1To (almost) quote a Loverboy hit from 1982, I hope you’re healthy when it’s over.

ObamaCare open enrollment was from November 15, 2014 to February 15, 2015. During that time you were able to enroll, switch plans, and apply for subsidies. All Private Health Plans share the enrollment period prescribed by the Health Insurance Marketplace (aka Exchange), while employer based coverage, Medicaid, and Medicare have their own unique enrollment periods.

That window has now closed. Perhaps you let it laps purposefully, and you wouldn’t be alone. On the other hand, it’s possible the deadline blew passed you while you weren’t paying attention.

So what happens if you missed it? Turns out, you actually have quite a few options within three categories: You can either apply for special enrollment, qualify for an exemption, or prepare to pay the fees. Let’s look briefly at each of these.

Pay the fees. The penalty for not having coverage will be paid on your Federal Income Tax Returns, based on your Modified Adjusted Gross Income (MAGI), for each full month you or a family member doesn’t have health insurance or an exemption. Depending on your coverage, income, and family size you will either pay a flat dollar amount, or a percentage of income above the tax return filing threshold for your filing status. The fee is capped at the national average for a Bronze health plan available in the marketplace, and is only paid for full months you or a family member went without coverage. The fee is technically called an “Individual Shared Responsibility Payment” and is part of the Affordable Care Act’s Shared Responsibility Provision.

Qualify for an exemption. You could qualify for an exemption from the individual mandate to have health coverage if:

  • You aren’t required to file a tax return because your income is too low
  • Your lack of insurance coverage was for only three months or less
  • The lowest-price health care coverage amounts to more than 8% of your income
  • You are part of a Native American tribe
  • You are in the U.S. illegally
  • You are a member of a health care sharing ministry
  • Your religion objects to insurance
  • You are incarcerated
  • You qualify for a hardship exemption

Applying for an exemption may take some effort, and the necessary application form depends on the exemption. Some exemptions can be claimed when you file your taxes; whereas others, like being a member of a religion that objects to insurance, require you to fill out an application form. These forms and related instructions can be found on the Healthcare.gov website.

Apply for a special enrollment. You can qualify for a myriad of reason, discussed in detail here; but the basics are as follows:

  1. Your health insurance plan is changing to include the new benefits required under health care reform in 2014
  2. Renewal of an individual medical plan in 2014 (grandfathered or non-grandfathered)
  3. You lose health insurance that is Minimum Essential Coverage due to:
    • Discontinuation of a current plan that does not meet health care reform requirements
    • Employer no longer offering group health insurance
    • No longer qualify for government-sponsored insurance
    • Divorce or legal separation
    • Termination of a domestic partnership or civil union (in states where applicable)
    • Change in full time employment status
    • Voluntary or involuntary termination of employment
    • Death of parent or spouse
    • Change in dependent status (i.e. dependent child turning 26 years old)
    • Change in student status; for example, graduating from college
  4. You are gaining or becoming a dependent due to:
    • Marriage
    • Domestic partnership (in states where applicable)
    • Birth of child/children
    • Adoption of child/children
    • Placement for adoption of child/children
    • Guardianship/court ordered dependent
  5. Other:
    • Permanently moving to a new state
    • Return from active duty
    • Release from incarceration
    • Gaining citizenship or valid immigration status

If you need help determining which option is best for you, let me know.

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