Tax Credits or Subsidies - Do I Qualify?

You may qualify for premium tax credits, or subsidies, to help pay for your health insurance if your total Modified Adjusted Gross Income (or MAGI) is between 100% and 400% of the Federal Poverty Level (or FPL) and you meet these requirements:

  • You live in the U.S.
  • You are a U.S. citizen, U.S. national, or lawfully present in the U.S.
  • You are not currently incarcerated.
  • You are not eligible for other minimum essential coverage.
How Much Are Penalties for No Coverage?

The tax penalties start small in 2014 and increase over time. By 2016, those without coverage will pay a tax penalty calculated at the greater of 2.5% of their taxable household income or $695 a year per adult and $347.50 per child (up to a maximum penalty of $2,085 per family). Beginning in 2017, the tax penalties will be increased by the cost-of-living adjustment. Although it is important to note that the tax penalty doesn’t apply if you have a gap in coverage of less than three consecutive months in any given year.

What if I have a medical condition?

Beginning in 2014, insurance companies are no longer allowed to ask any health questions on your application.  Pre-existing conditions are not an issue now. One question that is still relevant – Do you use tobacco?  Rates will be higher for tobacco users.

Will I lose my doctor?

With the passing of the ACA, new and smaller networks of doctors and hospitals were created. These smaller networks combined with a health insurance plan offer the lowest pricing. The smaller the network-the lower the plan cost. But when enrolling in a plan, you need to make sure that the network you attach to the plan has an adequate network to suit your personal needs. The cheapest rates are not always the best fit for you if you want to keep your doctors.

You may need to use a larger more expensive network.

Can I sign up any time?

Unless you have a life event such as having a baby, moving to a new area, or losing a job, you will only be allowed to purchase health insurance during the annual enrollment period.

The next open enrollment period for January 1, 2016 effective dates is expected to go from October 1 through December 15.

So next open enrollment will be October 1st, 2015 – December 15th, 2015.

What if I do not pay my premiums?

If you purchased your plan outside of the federal marketplace, you generally have a 30 day grace period, after 30 days of non-payment the plan would lapse for non-payment.

For plans purchased through the federal marketplace, there seems to be a 90 day grace period. Therefore, the plan does not expire for 90 days.

What if  you want the plan to continue after a change of heart, say with two months of premiums past due , you will be required to pay all back premiums.

Family of four to possibly qualify for subsidy- Income at or below

Family of three to possibly qualify for subsidy- Income at or below

Family of two to possibly qualify for subsidy- Income at or below

Single individual to possibly qualify for subsidy- Income at or below

What are the 2016 Obamacare enrollment deadlines ?

 

Although, the enrollment period for 2016 plans runs from November 1, 2015 through January 31, 2016 – you need to know that you will need to submit your enrollment by December 15th to secure a January 1st effective date.

If your enrollment is placed after the 15th of December but on or before January 15, your effective date will be February 1, 2016.