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- During open enrollment, those without insurance should go to healthcare.gov to get coverage
- After open enrollment, those without insurance should try to qualify for a special enrollment period
- Without health insurance, those that qualify may get coverage through Medicare, Medicaid, or the CHIP for minors.
- Without health insurance, individuals and families must pay for medical services directly
- Without health insurance, those that qualify may get emergency medical care from local hospitals and clinics.
- Without health insurance, those that qualify may get routine medical care from community-based medical service providers on a low-cost or no-cost basis.
The federal marketplace website at healthcare.gov or the state exchange will provide information to guide those who do not have insurance. The resources include treatment and medical services facilities, programs for insurance coverage, and assistance for low-income families and individuals.
When selecting a health insurance plan, most consumers get better value by comparison shopping than selecting on the basis of price alone. Enter your zip code on this page before you go to get started!
Medical Care for Uninsured Persons
There are federal and local resources for those without insurance and in need of immediate medical treatment or regular medical care. Many state agencies, local medical facilities, and cities provide emergency care for those in need of it. They provide assistance without regard to the ability to pay.
Uninsured persons can get medical care on a non-emergency basis at community-based medical clinics offering services on a low-cost or no-cost basis. Children and minors can get coverage through the CHIP, Children’s Health Insurance Program, and this includes dental care in many areas.
The Uninsured Risk the Individual Mandate
Without health insurance, each individual risks the penalty provision of the Affordable Care Act. The law requires that each person gets and keeps qualified health insurance coverage. Coverage must begin on the first day of the calendar year and continue for 12 consecutive months. Using comparison shopping, consumers can consider the best features of plans on the state exchanges or the federal marketplace.
Exemptions from the Penalty
The law provides for exemptions. The mandate does not apply to persons who are not lawfully present in the United States or its territories this includes undocumented immigrants. The law exempts persons with no taxable income such as recipients of SI benefits. The rules establish several forms of economic hardship that can provide temporary relief from the mandate and penalty.
The 2016 Individual Responsibility Penalty
Without health insurance, every eligible resident faces the individual shared responsibility penalty. The below-listed items describe the penalty for the calendar year 2016.
- The 2016 penalty amount for each uninsured adult is $ 695.00
- The 2016 penalty amount for each uninsured child or minor is $347.50
- The household penalty rises to a total equaling the greater of $2,895 or two and one-half percent of household income
The IRS applies the penalty as 1/12th of the total amount due for each month of no insurance.
Penalty for Calendar Year 2017
The penalty for no insurance will rise in 2017. The maximum penalty percentage of family income will remain at 2.5 percent. The federal government will adjust the limits for individual adult, child, and overall household dollar to account for inflation. The IRS will apply 1/12th of the adjusted amount for each month of no insurance.
Income that Qualifies for Obamacare
There are minimum income levels for Obamacare participation and maximum levels for its benefits. The minimum income to qualify for a marketplace policy is 100 percent of the federal poverty guideline figure. In 2015, that amount was $11,700. In states that adopted Medicaid expansion, persons with income of 138 percent of the poverty line can get Medicaid. Income includes all taxable income from any source.
Getting Medicaid Coverage
Medicaid is a medical care program. Medicaid is a public program; the federal government provides most of the funds, and state governments run the programs. Healthcare.gov routinely refers applicants that cannot qualify for Obamacare to the state agencies that operate Medicaid.
Jobs can provide health insurance for those without coverage. Employers with 100 or more employees must cover their full-time equivalent employees with qualified health insurance. Those with 99 or fewer full-time equivalent employees must offer health insurance to their employees. Employers with 49 or fewer employees can get tax benefits for providing health insurance to employees. This includes the SHOP program for small businesses with incentives and tax credits.
Affordable Employer-sponsored Insurance
Employer-sponsored insurance must cost no more than 9.5 percent of annual family income. Should the employer offer insurance that exceeds 9.5 percent, the employee may be able to get affordable insurance on the federal or state marketplace.
Affordable Marketplace Insurance
The ACA guarantees affordable health insurance coverage. It defines affordable coverage for an individual as eight percent or less of the annual household income. Those that cannot find available affordable coverage can get an exemption from the individual mandate and penalty.
Qualified Health Plans
The Affordable Care Act provides no cost features to improve health by prevention and early detection of diseases. These includes extensive screenings, lab work, and tests for physical and mental health conditions. Policies sold on the federal website or state marketplaces must have these essential health benefits; they are qualified health plans.
Open Enrollment for Health Insurance
The open enrollment is an important time for health insurance. Every eligible resident can purchase, renew, or switch health insurance. They can get coverage with qualified health plans and satisfy the individual mandate. Comparison shopping is an effective method for finding the best value for a family’s or an individual’s health care needs.
Open Enrollment for Medicare
Medicare enrollment satisfies the individual mandate and provides essential health benefits. Medicare eligibility depends on physical or mental health, disability, age, work history, and date of birth. Individuals that meet the rules for disability can enroll at that time.
Open Enrollment for Medicaid and the CHIP
Medicaid and the CHIP do not have enrollment periods. They have continuous enrollment for those that qualify by income and need. Both Medicaid and the CHIP satisfy the mandate for qualified insurance coverage. Those enrolled in either will not have to pay a penalty for the time covered in these programs.
Special Enrollment Periods for Life Events
Federal rules accept the below-listed changes in status as life events. They create a 60-day period to buy insurance.
- Giving birth to a child
- Reaching the 26th birthdate
- Losing employer-sponsored coverage as an employee
- Losing employer-sponsored coverage as an employee’s dependent
The Individual Mandate Without Insurance
One can buy temporary policies and gain some coverage after open enrollment. These short-term policies will not avoids the penalty. When selecting health insurance at any time of the year, comparison shopping will help get the best possible result. Comparison shopping is an excellent way to compare the parts of health plans of most importance. The ACA groups insurance plans by similarities in levels of paid benefits. Consumers can use comparison shopping to focus on their particular needs and preferences.
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