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What if I can’t afford healthcare?

Keep in mind...
  • If you do not have insurance but you can afford it, you will be responsible for paying the individual mandate fine
  • If you cannot afford health insurance, you have a number of options
  • If the lowest cost plan on the marketplace or through your employer costs more than 8 percent of your modified adjusted gross income, you will be exempt from paying the fee for not having insurance
  • You can apply for Medicaid in your state if you think your income will qualify you
  • If you were exempt from the health insurance individual mandate due to hardship or affordability, you can still purchase a catastrophic plan through the healthcare marketplace or a private company
  • If you were recently terminated from your job, you also have a number of unemployment options such as COBRA coverage

What is the penalty for not having health insurance?

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If you do not have health insurance, you may be responsible for paying a penalty fine. There are many exemptions from the individual mandate due to hardship and affordability reasons, so you may not always have to pay it. It is charged in one of two ways.

You will either be responsible for paying $695 per adult and $347.50 per child in your household who went without insurance up to a maximum of $2,085 or you will have to pay 2.5 percent of your household income.

You will be responsible for paying whichever of these two fines is greater.

The total maximum for any fine is equivalent to the average cost of a bronze healthcare plan. If you had coverage for part of the year, you will only be responsible for paying the fine for the time that you went without insurance. In this instance, you only have to pay 1/12th of the annual fee for each month.

If were only without insurance for no more than two full months, you may qualify for short coverage gap exemption and not have to pay the fine at all.

You will pay this fee when you file your tax returns for the previous year. If you do not pay the fee, the only way for the IRS to collect on it is to withhold it from your tax refund the following year. The IRS cannot enforce this fine with jail time or other typical collection ways.

Don’t go without coverage and face the tax penalty; enter your zip above and find the right health insurance agency for you.

What do I do if I can’t afford it?

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If you cannot afford health insurance, there are several options you should consider. There are also several exemptions to the fine you may qualify for based on your income or hardship experiences.

You can apply for Medicaid at your local Medicaid office or through the Healthcare Marketplace website. Your eligibility for Medicaid is determined by your modified adjusted gross income.

Health insurance is considered truly unaffordable for you if the lowest cost plan or the plan offered by your employer costs more than eight percent of your total modified adjusted gross income. If this applies to you, you will be exempt from the penalty fine for not enrolling in health insurance.

There may be several other exemptions that you qualify for including your income being below the tax filing threshold, you only had a short coverage gap, or if you were ineligible for Medicaid in your state because it is a state that chose not to expand Medicaid. If any of these exemptions apply to you, it may be a good idea for you still enroll in catastrophic health coverage in case of an emergency.

What is a catastrophic health plan?

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If you are under the age of 30 and qualified for an exemption based on hardship circumstances, you qualify for a catastrophic plan that comes with a high deductible and a low premium. These plans are your cheapest option that still meet the minimum essential coverage requirements set forth by the Affordable Care Act.

They typically do not consider anything besides three primary care visits before your plan’s deductible has been met.

If you are over the age of 30 or do not qualify for a hardship exemption, you can still purchase a catastrophic plan, however, it will not exempt you from having to pay the individual mandate penalty fine.

These plans are really only there to cover an emergency and to ensure you will never pay more than your out of pocket maximum if an emergency does occur. The maximum out of pocket amount for all plans, including catastrophic coverage, can not exceed $6,600 for an individual and $13,200 for a family. In addition to your primary care visits, they may also cover some screenings and vaccinations prior to your deductible being met.

What are my options if I am recently unemployed?

If you recently became unemployed and lost your job-based insurance, you may have the option to continue your coverage for a limited period of time with COBRA insurance. COBRA typically counts as qualifying minimum essential coverage under the Affordable Care Act, so you will not be responsible for paying the fee.

If COBRA is still too expensive for you, you have options through the Healthcare Marketplace. 

You can purchase a plan during open enrollment or during a special enrollment period if you qualify if you see one that is cheaper. You should apply for Medicaid in your state, as well as the Children’s Health Insurance Program if you need coverage for your children. This program is available for those whose income is too high for Medicaid, but still need assistance in paying for their children’s health care needs.

Your household size and your income determine whether or not you are eligible for any of these free or low-income insurance programs, not your employment status.

If you are receiving unemployment compensation, that will count towards your income when determining eligibility for these programs. Therefore, you may still need to purchase an insurance plan or be responsible for paying the individual mandate fine, even if you are unemployed.

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