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- The Individual Mandate of the Affordable Care Act requires Health insurance coverage
- Those without coverage may have to pay a share responsibility penalty
- The 2016 penalty is $695.00 for an adult, $347.50 for a minor
- The family unit penalty for the calendar year 2016 is $2,085.00.
- The ACA provides for exemptions from the Individual Mandate
Health insurance protects individuals and families by providing preventive care and covering most of the expenses of medical treatment. The Affordable Care Act requires qualified health insurance for everyone. Comparison shopping is the best way to select health insurance and find the best values. Start comparing health insurance rates now by using our FREE tool above!
Preventive health services are important. It is simply easier and better to maintain good health than to attempt to cure disease. Qualified health plans provide essential benefits, and they include health screenings and mental health services. Qualified health plans protect individuals from high medical costs because even relatively minor procedures will cost thousands of dollars when it involves hospitalization.
The once per year period for sign up is called Open Enrollment. For the calendar year 2016 it runs from November 1, 2015, to January 31, 2016. It is the time when everyone has a right to review, select and purchase qualified health plans that satisfy the Individual Mandate of the Affordable Care Act. Open Enrollment is also the end of the time allowed for sign-up. Private plan providers also observe the Open Enrollment limitation. The special enrollment periods require proof of a Life Event.
Exemptions from the Mandate
The Affordable care Act contains exemptions from the individual mandate for hardship and other circumstances. Exemptions from the Individual Mandate are described below.
- Unaffordable coverage- when coverage exceeds eight percent of income
- Hardship- financial hardships are grounds for exemption
- Persons below the threshold for filing a tax return are exempt
- Medicaid and CHIPs coverage satisfy the individual mandate
- The government can grant hardship status to consumers that experience three months or less without coverage.
The Obamacare Metal Plans
The Affordable Care Act rates qualified health plans by the amount of coverage provided by insurance versus the amount left for payment by the consumer. Called the actuarial value, these ratings help consumers compare plans that have similar amounts of insurance paid services. The four types of health Insurance sold on the Obamacare exchanges are listed below:
- Platinum Plans cover the highest amount of plan services and leave the least amount of consumer payment. They have high premiums and lower deductibles and out of pocket expenses than other plans. Platinum level pays for about ninety percent of plan costs.
- Gold Plans cover a large percentage of plan costs with insurance, about 80 percent
- Silver Plans covers seventy percent of plan costs with insurance leaving about thirty percent for the consumer. These plans offer payment assistance from the government for those who qualify with incomes below 250 percent of the poverty line.
- Bronze Plans are the most affordable class of qualified health plans. They offer low premiums, high deductibles and high out of pocket costs. Bronze plans pay sixty percent or more of service costs.
Many important services such as screenings and annual physical exams are covered under Obamacare with no out of pocket costs or co-pays. This is an essential layer of protection for health. Doctors can prevent many more complicated conditions by early detection of health issues such as diet, cholesterol levels, blood pressure, and pre-disposition to diabetes.
Protection Against High Costs of Care
Qualified health plans were designed to protect consumers against the high costs of medical care. People have been shocked and damaged by the costs of relatively simple procedures such as a tonsillectomy that might cost tens of thousands of dollars without health insurance. The ACA restricts insurers; they can no longer impose arbitrary limits and lifetime limits on care that reduce the consumer’s ability to get quality healthcare.
After the Open Enrollment, the ACA provides special enrollment periods for these significant changes of status that require an opportunity for sign-up. The ACA recognizes Life Events as an exception to the rule against sign-ups after Open Enrollment. Life Events include the below-described items.
- Moving to a different state
- Having a baby
- Adopting a child
- Loss of insurance as a dependent
- Loss of insurance by loss of a job
Get the Best Plan for You
Everyone needs health insurance for healthcare services and protection against the costs of medical treatment that may arise. Those with incomes near or over the 400 percent of federal poverty line threshold will get very little if any premium subsidy. These consumers should shop outside of Obamacare to find all available plans in their area. Comparison shopping helps consumers find the best fit for their health insurance needs. Start comparing health insurance rates now by entering your zip code in our FREE tool below!