Two weeks left for open enrollment to healthcare’s Marketplace


March 19, 2014 - 12:00 AM

With less than two weeks remaining in the Marketplace’s open enrollment period it is a good time to look at the penalties for not obtaining insurance coverage and what exemptions are available to avoid those penalties.
The Marketplace’s first open enrollment period began Oct. 1 and continues through March 31. After open enrollment closes an eligible person can obtain coverage only if a special circumstance exists. These special circumstances include life event changes such as job change, aging out of coverage from a government program or getting married or divorced.
Part of the Affordable Care Act or ACA (“Obamacare”) known as the Individual Mandate, requires that almost everyone must have health insurance coverage that meets certain standards. Policies that meet these requirements are know as Qualified Plans. Most people will meet this requirement through their own or family member’s jobs. Many others will meet the requirements through Medicare, Medicaid, VA coverage or Child Health Insurance Programs (CHIP). Together, these groups make up the vast majority of Americans. People with these types of insurances don’t need to do anything to comply with the ACA. The Marketplace, with tax credits to help with premiums and help with deductibles and co-pays for eligible persons, is meant to be an affordable way to help those without any of these kinds of coverage to comply with the law. In Allen County about 15 percent of the population does not have coverage and could benefit from the Marketplace.
Failure to get health insurance subjects a person to a tax penalty on their 2014 tax return, lowering their refund or causing an increase in the amount owed. This penalty is set as the greater of either 1 percent of income over $10,150 (amount of filing threshold) for your entire household OR $95 for each uninsured adult and $47.50 for each uninsured child up to a maximum of $285 per household.
In 2015, this increases to 2 percent or $325 per person. In 2016, it is 2.5 percent or $695 per person. After 2016, it is indexed for inflation. If you are uninsured for more than three months, but insured part of the year, the penalty is reduced by one-twelfth for each month you have coverage.
But not everyone is subject to the penalty.
The follow exemptions may be obtained either by Marketplace application or on the 2014 tax return:
• Coverage being unaffordable (more than 8 percent of income)
• Membership in a health care sharing ministry
• Membership in a federally recognized tribe
• Being incarcerated

THE FOLLOWING exemptions require a Marketplace application:
• Membership in a recognized religious sect whose members object to insurance
• Eligibility for services through an Indian health care provider
If you do not earn enough income to require that you file a tax return, you do not have to take any action at all to receive your exemption.
Marketplace applications for an exemption can be found at
Hardship exemptions may be available based on a number of criteria, including:
• Homelessness
• Eviction in the past sixmonths or facing eviction or foreclosure
• Receiving shut-off notice from a utility company
• Recent domestic violence
• Recent death of a close family member
• Fire, flood, or other natural or human-caused disaster
• Bankruptcy in the last six months
• Medical expenses that could not be paid in the last 24 months
•  Unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member
• Winning an eligibility appeals decision in the Marketplace
• You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid
• Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable

I WOULD strongly recommend filing an exemption application for anyone who could not receive financial help on the Marketplace because their income was too low and could not get Medicaid because Kansas declined to expand Medicaid.
Do this even if your income is so low do not need to file a tax return. Not only will this assure that no penalty will be charged, it also will help establish a “special enrollment period” if your income increases during the remainder of the year. This could permit financial help in paying for coverage even if the applicant was previously turned down for assistance. If you are uncertain about how to apply for this exemption please talk to a Navigator.

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