FAQ: A big day for the ACA

Posted March 31, 2014, at 5:52 p.m.

March 31 is the deadline to enroll in health insurance?

For most people, yes. But the Obama administration will allow anyone who tried unsuccessfully to sign up through Healthcare.gov — because of technical issues or other problems — by March 31 extra time to submit an application. How much extra time? The feds have been vague, saying mid-April. They’re also taking Americans at their word, asking consumers to attest to experiencing technical glitches without requiring proof.

If you didn’t start to enroll by midnight Monday, you won’t be able to get private health insurance as an individual until 2015, unless you experience certain life-changing circumstances that grant you a special enrollment period.

Circumstances like what?

If you get married, have a child, lose a job, get a divorce, move out of state or experience some other change that affects your health insurance, you may qualify for another chance to sign up. But if your life rolls on much like it did last year, then Nov. 15, the start of the 2015 enrollment period, will be your next chance to sign up.

So, I must have health insurance now?

Yes, unless you are very poor (under the federal poverty level) and live in a state that didn’t expand Medicaid (like Maine).

If you have affordable insurance through your employer, you’re all set. Likewise, if you get health care through the military, Veterans Affairs, Medicare, Medicaid or some other insurance program.

What if I don’t sign up for health coverage?

Unless you apply for and get an exemption, you’ll have to pay a penalty.

You can get an exemption to the penalty if:

— Your religion prevents you from accepting insurance benefits.

— You are part of a health care sharing ministry.

— You are a member of a federally recognized Indian tribe.

— You lack insurance for less than three months in a row.

— You have suffered a certified hardship.

— You can’t afford coverage because you’d have to pay more than 8 percent of your household income for coverage.

— You’re behind bars.

— You are not a U.S. citizen, a U.S. national or an alien lawfully present in the U.S.

The penalty’s $95, right?

Not exactly, you could pay a lot more.

First, to be subject to the penalty, you have to meet the threshold that requires you to file a tax return. That’s $10,150 for an individual, $13,050 for a head of household and $20,300 for a married couple filing jointly.

For 2014, the penalty will total 1 percent of family income or $95 per adult and $47.50 per child (up to $285 per family), whichever is more. In 2015, the penalty jumps to 2 percent of income or $325 per adult and $162.50 per child (up to $975 per family), whichever is more. And in 2016, the penalty will be 2.5 percent of income or $695 per adult and $347.50 per child (up to $2,085), whichever is more.

So someone earning $25,000 annually would face a $150 penalty if they lacked coverage all year.

What happens if I don’t pay the penalty?

The IRS may dip into your income tax refund next year to collect the penalty, but not much beyond that. The health reform law prohibits the IRS from garnishing wages or imposing liens in cases where individuals fail to fork over the penalty.

Can I apply for MaineCare after March 31?

Yes. You can put your information into Healthcare.gov to see if you’re eligible, but to actually sign up, go the old-fashioned way — get an application from your local DHHS office, download a copy of the application or call MaineCare Member Services at 800-977-6740.

 

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