1. Why is there a mandate that everyone buy health insurance?
The health care law includes what is called an individual mandate that requires everyone — whether they are young, healthy, older or sicker — to have health insurance. There is also a provision that requires health insurance companies to accept everyone for coverage regardless of their health status. Both of these provisions start on Jan. 1, 2014.
The mandate is a vital part of expanding access to health care, because it spreads the risks and costs of providing health insurance to everyone. With the mandate in place, health insurance companies will provide coverage to healthy people who use fewer health care services, as well as unhealthy and older people who use more health care services and are consequently more expensive to insure.
There are some exceptions to the individual mandate. You may qualify for an exemption if:
- You are a member of a Native American tribe
- You are incarcerated
- You are part of a religion that objects to health insurance
- You are an undocumented immigrant
- Your income is below the threshold that requires you to file a federal income tax return
- You would have to pay more than 8 percent of your income on your health insurance (this is after applying any employer contributions or tax credits)
2. What if I don't have insurance?
The mandate takes effect January 1, 2014. After that time, the government will impose a financial penalty each year if you do not have health insurance coverage. You will pay penalties for each uninsured adult and child in your family up to a certain maximum. The penalty amount for children under the age of 18 is half the amount adults will pay. The penalties for not having health insurance increase over the next few years. If you have no insurance, you will be charged the greater of these penalty amounts:
- 2014 penalty — $95 per individual and $47.50 per child (up to a maximum of $285 per family) OR 1 percent of your income
- 2015 penalty — $325 and $162.50 per child (up to a maximum of $975 per family) OR 2 percent of your income
- 2016 penalty — $695 and $347.50 per child (up to a maximum of $2,085 per family) OR 2.5 percent of your income
After 2016, these amounts will increase based on cost-of-living adjustments. The Internal Revenue Service will assess these penalties when you file your annual income tax returns.
3. What if I can’t afford health insurance?
The ACA requires that all Americans have health care coverage or they may face a penalty. The ACA is aimed at making health insurance coverage more accessible and affordable for Americans, and one way the law helps make this possible is by providing financial assistance to help cover the cost of health care.
The government offers financial assistance in the form of tax credits and/or premium subsidies to help people pay for health insurance. The tax credits will be based on your annual income (how much money you make each year), where you live, the number of people in your family and if you are a citizen of the United States or lawfully present in the United States.
If you qualify, you may be able to:
- Get free health insurance through Medicaid.
- Reduce your monthly premium costs.
- Lower the cost-sharing amount you pay each time you need medical care.
- You’re uninsured for less than three months of the year
- The lowest-priced coverage available to you would cost more than eight percent of your household income
- You don’t have to file a tax return because your income is too low
- You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
- You’re a member of a recognized health care sharing ministry
- You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
- You’re incarcerated and not awaiting the disposition of charges against you
- You’re not lawfully present in the U.S.
5. What is the deadline to buy health insurance?
The enrollment period for 2014 ended on March 31, 2014. However, if you experience a life event change, you may be able to apply for individual coverage after March 31, 2014. Most likely, you will need to complete your application within 60 days of your life event.
Examples of life event changes include:
- Giving birth to a baby.
- Moving to a different state.
- Losing your health care coverage from your employer.
- Becoming eligible for different products due to changes in your income.
6. How do I buy the required health insurance?
Independence Blue Cross has an easy-to-use website, www.ibx4you.com, where you can compare and buy your health insurance plan based on what matters to you the most. Our shopping tool can guide you with simple questions to help determine the health insurance plan that best meets your needs. You can also browse all available plans in your area, sorting coverage options by plan features and costs. Then you can select a plan.