By Kevin Counihan
5 Facts for Consumers about the Fee for
Not Having Health Coverage
One of the best parts of my job is
the time I spend during Open Enrollment out on the road, talking with people
who are looking to sign up for coverage at HealthCare.gov. The people I meet often
ask questions about my role as CEO of HealthCare.gov and why I’m visiting their
community. My answer is always the same. I believe all families deserve the
peace of mind and financial security that comes with access to quality and
affordable health care coverage, and I want to do everything I can to help them
get enrolled.
No family should live in fear that
one unexpected illness or an accident could throw them into financial turmoil.
All people deserve the relief that comes with knowing you can fill your
prescriptions, take your children to the doctor, and get care to stay healthy
when you need it. The good news is, affordable coverage through HealthCare.gov
is available. After financial assistance, 7 out of 10 people can find plans
with premiums of less than $75 dollars per month.
As I talk with people, my priority
is to make sure they are informed about the options available to their
families. Part of that means making sure people know that having health
insurance when you can afford it is now the law. If you can afford health
insurance, but you choose to not enroll in coverage for 2016, you may be
required to pay
a fee when you file your 2016 federal income taxes. Sometimes people also
refer to the fee as a penalty, fine, or individual shared responsibility
payment.
I
believe your best option is to learn about the tax credits that are available
and to visit HealthCare.gov to enroll in a plan that meets their needs, rather
than taking the risk of going without insurance and paying a fee.
Here are 5 facts you should
know about the fee for not having health coverage when you can afford it:
- The
fee is calculated one of two different ways, depending on your situation. The fee for not having
health insurance if you can afford it is calculated either as a percentage
of your annual household income or a set amount for each person in your
household who does not have coverage. When
you file your federal income taxes, if you are uninsured for more than
three months despite having access to affordable coverage, you’ll be
required to pay whichever amount is higher. Resources on HealthCare.gov
will help you estimate
the fee you’ll have to pay
if you don’t have health insurance based on your own situation.
- The
fee is increasing for 2016. For 2015, the fee for not having health insurance if
affordable insurance is available to you and you don’t qualify for an
exemption is $325 per person or 2 percent of your annual household income
– whichever is higher. For 2016, the fee you’ll have to pay if you choose
to go without health insurance will increase to $695 or 2.5 percent of
your income – whichever is higher. For many people, that’s more than the
yearly cost of affordable plans they can find on the Marketplace.
Generally, the higher your income, the higher the fee you will have to
pay.
- Every
month without coverage counts. The fee is calculated based on the number of months
you, your spouse, or your tax dependents went without qualifying
coverage, such as an employer-sponsored health plan, Medicare,
Medicaid or coverage through HealthCare.gov. The more months you go
without health coverage, the higher the fee you will have to pay, up to
the maximum.
- For
some people, exemptions from the fee are available. People with very low
incomes and individuals who meet other specific conditions can receive an
exemption from the requirement to have health insurance and will not have
to pay the fee. Additional information about exemptions and a tool
that helps you determine if you qualify for an exemption is available
on HealthCare.gov.
- If you need health
coverage and want to avoid the fee for 2016, enroll in a plan by January
31.
It’s important to remember that the final deadline to sign up for 2016
coverage through HealthCare.gov is January 31. A Special Enrollment
Period around the April 15 tax filing deadline will not be offered this
year. If you don’t enroll by then, you could have to wait another year
to get coverage and may have to pay the fee when you file your 2016 income
taxes.
If
you have questions or want to learn more about either the fee or how to sign up
for coverage through HealthCare.gov, there are a number of ways to find free,
personal help. Enrollment specialists are available 24 hours a day, every day
at 1-800-318-2596. Free, confidential, in-person assistance is also available
at enrollment sites and events in communities across the nation. Visit LocalHelp.HealthCare.gov
to find local help in your neighborhood.
Remember
that the final deadline to sign up for 2016 coverage through HealthCare.gov is
January 31. However, if you need coverage and want it to begin as soon as
January 1, 2016, you need to sign up by December 15.
Don’t
miss your chance to get covered, visit HealthCare.gov today.
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