The deadline to purchase health insurance plans under the Affordable Care Act is one week away.
Open enrollment began Nov. 1 and ends Friday, Dec. 15.
Those who do not enroll in a qualifying plan during the open enrollment period will be unable to purchase health insurance in 2018 unless they have a qualifying event such as loss of job, marriage, divorce, birth of a child, or moving to a different ZIP code or county.
Despite efforts in Congress to alter or overturn the Affordable Care Act, the law remains in place. Insurance industry experts say the individual mandate, and the tax penalties that go with it, are not going anywhere in 2018.
If you are not already enrolled in a public or private health care plan or do not have health insurance through an employer-provided plan, the open enrollment period is the time to purchase coverage or risk paying a tax penalty.
Those who purchased plans through a public or private insurance marketplace have the opportunity to renew the same plan or shop for different coverage during the open enrollment period. In most instances, you will be automatically re-enrolled in your same plan. However, if your insurance company withdraws altogether from the state marketplace you are enrolled in, your coverage will lapse and you will need to pick a new plan and provider.
Not having health insurance could cost you at tax time. The penalty for not having an ACA-compliant insurance plan or forgoing coverage in 2017 is the greater of $695 per adult and $347.50 per child for a maximum of $2,085; or 2.5 percent of adjusted household income. The percentage penalty is capped at an amount equal to the national average premium for a bronze plan, the minimum coverage available by law. Beginning in 2017, the flat fee portion of the penalty will be indexed to inflation. Fees are paid as a part of the filing process for federal income tax returns.
One of the ways in which the ACA attempts to make health insurance more affordable is by offering tax subsidies to qualified individuals who purchase insurance through state or federal exchanges. Those applying for subsidies can make up to 400 percent of the federal poverty level in order to qualify.
Although the individual mandate requires most Americans to carry a minimum level of insurance coverage, there are some important exceptions and special qualifications. Those exemptions include certain religious groups and Native American tribes; undocumented immigrants (who are also not eligible for insurance subsidies); incarcerated individuals; people who have VA medical care; people whose incomes are below the threshold for filing tax returns; and people who live in states that have not expanded Medicaid programs and would have qualified for Medicaid under the expanded coverage.
For a full list of exemptions and information on how to file for one, visit HealthCare.gov.
Consumers with questions are encouraged to contact the HHS call center at 800-318-2596 or visit the website above to find local help. Agents in OOIDA’s Medical Benefits Group also are available from 7:30 a.m. to 5:30 p.m. CST, Monday through Friday, at 800-715-9369 or via email at MedBen@ooida.com.
While OOIDA no longer offers individual major medical insurance plans, the Association’s Medical Benefits Group now offers minimum essential coverage plans for individuals and families. The plans offer coverage of preventive services and screenings, while also satisfying the requirements of the individual mandate under the Affordable Care Act.
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