Did you sign up for healthcare coverage through a private insurance exchange? If not, you are probably out of luck until November. The “soft” deadline for insurance enrollment through the healthcare exchanges was March 31, but anyone who was “in line” to sign up for coverage through the Affordable Care Act on that date was given another two weeks to sign up. That deadline has also passed.
Since you’ve missed both the “soft” deadline and the “drop dead” deadline, you may be liable for a financial penalty as a result of the individual mandate. If the subsides were the “carrots” of the ACA, the individual mandate is the “stick” – designed to maximize compliance among a public which has been decidedly lukewarm about President Obama’s signature legislative accomplishment. But even though you’re late to the table on Obamacare, you may still dodge the individual mandate bullet.
Do You Already Have Health Care Coverage?
If you have health insurance that complies with the minimum standards of the ACA, either through an employer, as a college or university student or as a member of your parents’ healthcare plan, relax. Likewise, if you purchased an individual insurance policy outside the exchange that meets the minimum requirements of the ACA on or before March 31, you’re good. The ACA was never intended to compel people who already have satisfactory health insurance coverage to seek coverage through the exchanges.
If you qualify for Medicare (or will become eligible during the year), either because you are an American citizen over age 65 or are eligible for Social Security disability payments, you are also in good shape. In all these cases, you are considered to be in compliance with the individual mandate and need not worry about a financial penalty. You may also apply for Medicaid or the Children’s Health Insurance Program (CHIP) at any time.
Small Business Owners (and Employees)
As a small business owner with 50 or fewer employees, you are entitled to establish health insurance plans to cover their employees at any time during the year through the Small Business Health Options Program (SHOP). You are also eligible for tax credit when you file your 2014 federal income tax return. You will need to obtain a SHOP eligibility notice from the SHOP marketplace to claim the credit.
You May Still Be Eligible to Enroll for Obamacare Through the Exchanges
Did you have a baby or adopt a child? Did you move from one state to another? Have you lost your employer-provided healthcare coverage because you were fired or laid off? Did you encounter technical glitches or receive inaccurate advice that caused you to be unable to obtain coverage? Were you the victim of a natural disaster or a survivor of domestic violence? These and other changes in life circumstances or complex personal circumstances qualify you for enrollment outside the open enrollment period.
If you believe that your situation qualifies you to enroll for coverage through the exchanges outside the Open Enrollment window, contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). If you do qualify for special enrollment status, the representative will assist you in obtaining coverage. You will also be exempt from paying the penalty under the individual mandate.
Are You Exempt from the Individual Mandate?
In some instances, you may be exempt from paying a penalty under the individual mandate even if you remain without health insurance coverage. To obtain the exemption you must apply in writing by submitting the appropriate form available through Healthcare.gov. The exception is if you have a health insurance gap of less than three months, in which case no form is necessary.
For instance, if you are homeless, if the least expensive policy available to you would cost more than 8 percent of your household income, or if your income is so low that you are not required to file a federal income tax return, you are exempt, even if you do not obtain insurance. Likewise, if you are a member of a qualified Native American tribe or health care sharing ministry, you are also exempt. If you are incarcerated through the local, state or federal correctional system, or if you are an undocumented resident of the United States, no payment under the individual mandate is expected from you.
If You Have to Pay, You May Be In for Sticker Shock
Some people simply forgot to enroll, and or figured they could skip Obamacare and try to stay healthy. For those people, the fines could be aplenty.
You may have heard or read that the penalty for failure to enroll in a qualified health insurance plan is $95 and decided that you would eat the Benjamin and skip out on Obamacare. If so, you may be in for an unpleasant surprise. The actual fee for 2014 is $95 for each adult in your household or 1 percent of your income, whichever is greater. If your income is more than $19,650 your penalty would be nearly $200. If you have children, the 2014 fee for each child under the age of 18 is $47.50, up to a maximum of $285. If you obtain a qualified insurance plan after March 31 but before the end of 2014, your penalty will be 1/12 of the total penalty for every month that you remain uninsured. The fee will be due and payable on your April 2015 federal income tax return.
The price tag for the individual mandate fee jumps even higher in subsequent years. If you fail to obtain a qualified health insurance policy in 2015, unless you are exempt, you will be subject to a penalty of 2 percent of your income or $325 per person, whichever is greater. In 2016 the penalty increases to 2.5 percent of your income or $695 per person, whichever is higher. After 2016, the penalty is adjusted for inflation. Cha ching!
Your Alternatives Until November 15
If you missed the initial Open Enrollment period and do not qualify for special enrollment, you must wait until November 15 for the next open enrollment window. The good news is if you get sick or suffer a serious injury, the emergency room of your neatest hospital must provide treatment for life-threatening illness or injuries.
You may also be eligible for charity care if you receive treatment from a nonprofit hospital. Local clinics or community organizations may also provide preventative care or treatment for chronic conditions. Explore any and all resources at your disposal – and mark your calendar so that you don’t miss the next Open Enrollment period.
Audrey Henderson is a Chicagoland-based writer and researcher. She holds advanced degrees in sociology and law from Northwestern University. Her writing specialties are sustainable development in the built environment, policy related to arts and popular culture, socially and ecologically responsible travel, civic tech and personal finance.