Guest Blog by Ciara Johnson, RWV-NY Intern and MSW Student at Columbia University
The rate of uninsured people in the United States has dropped to 11 percent, according to a Gallup poll released earlier this month. That’s the lowest uninsured rate since Gallup began tracking it eight years ago. Still, that is a lot of people facing potential penalties as this year’s tax deadline approaches. What do you need to know if you are one of these uninsured people, or you are someone working with uninsured people? Here are a few tips.
The penalty for not having health insurance has gone up again this year. April 18 (yes, the IRS has changed the deadline for this year!) is the third tax deadline for which the Affordable Care Act (ACA) penalties for not having health insurance will apply. According to the healthcare.gov, this year’s penalty went up from 2 percent to 2.5 percent of your yearly household income. With the increase, you will have to pay roughly $695 per adult and $347.50 per child under 18. The maximum penalty, which is equal to the cost of the yearly premium for a bronze plan, is $2,085.
Anyone who can afford health insurance as determined by your yearly income, but chooses not to buy it, will have to pay a penalty.
Who is exempt from the tax penalty? Generally, whether you qualify for an exemption from the tax penalty depends on your household income. If the lowest priced bronze-level health plan available to you through the health insurance marketplace in your state costs more than 8.05% of your household income, then your coverage is considered to be unaffordable. In this case, you can claim an exemption by filling out and submitting IRS Form 8965 with your 2015 tax return. You can also mail in an exemption application.
An exemption can also be granted based on a number of circumstances. Many are “hardship” exemptions for people who have suffered bankruptcy, the death of a close family member, eviction, homelessness, caring for an ill family member or other disruptive life events. Other exemptions are for categories of people, such as Native Americans and people who have religious objections to medical care. For more information on the exemptions process, visit healthcare.gov.
Couldn’t afford the expensive coverage your employer offered? You will qualify for an exemption from the tax penalty if you can show that the cost of the coverage would have been more than 8.05 percent of your income.
What if you had health insurance for part of the year? If you only lacked coverage for one or two months during 2015, then you will qualify for the “short gap exemption” from paying the penalty. If you were uninsured for a longer period, you will pay a fee that is a pro-rated fraction of the annual penalty. So, for example, if you were uninsured for six months, you would pay half the annual penalty.
If you are facing a penalty, can you sign up for coverage now and avoid paying it? No. In previous years, there was a special enrollment period that allowed still uninsured people to apply for affordable private health insurance through the ACA marketplaces at tax time. However, there is no special enrollment period this year for those facing penalties for being uninsured in 2015.
The next open enrollment period for marketplace coverage starts November 1. It would be a good idea to mark this date on your calendar if you are still uninsured and facing a tax penalty this month. However, be aware there are some circumstances in which you can apply for coverage before then. For example, if you experience a “qualifying life event,” such as getting married or having a child (and in New York, becoming pregnant or suffering from domestic violence or spousal abandonment), you may apply for coverage right away during a Special Enrollment Period. In addition, people can apply for Medicaid and Children’s Health Insurance year round. Examine whether you might qualify for one of these options by contacting a Navigator, or going to New York’s Marketplace, NY State of Health.
If you do have health insurance coverage, how must you prove this when filing your tax return? You are not required to submit proof of health care coverage when filing your tax return, but you should keep these records on hand to verify coverage if necessary. Acceptable forms of proof of insurance include: 1095 information forms sent to you by your insurer or employer, insurance cards, explanation of benefits statements from your insurer, W-2 or payroll statements reflecting health insurance deductions, records of advance payments of the premium tax credit and other statements indicating that you, or a member of your family, had health care coverage.
Welcome to National LGBT Week of Action for Enrollment! The U.S. Department of Health and Human Services (HHS), the White House, Out2Enroll and partners across the country and New York State are collaborating this week to reach uninsured LGBT people and get them enrolled in health insurance for 2016. The deadline to apply for coverage that starts January 1 is next week, December 15.
Members of the Health Care For All New York (HCFANY) LGBT Task Force are providing culturally competent enrollment assistance for LGBT New Yorkers, helping them apply for coverage through the NY State of Health Marketplace. These Task Force members include the Community Service Society, Callen Lorde Community Health Center, the LGBT Community Center in Manhattan and its partner in Queens, Voces Latinas, GMHC and Make the Road New York.
The National LGBT Week of Action for Enrollment celebrate the immense progress for LGBT health policy over the last few years since passage of the Affordable Care Act (ACA). HHS LGBT Issues Coordinating Committee Co-Chairs Kathy Greenlee and Wanda Jones took the opportunity this week to launch the 2015 HHS LGBT Annual Report and described new potential efforts to require electronic medical records systems to collect information on gender identity, sex assigned at birth and sexual orientation by 2018. Other exciting advancements include (1) proposed regulations implementing section 1557 of the ACA will bar discrimination against LGBT people in health care coverage and access, (2) a proposed Center for Medicare and Medicaid Services (CMS) National Coverage Determination Criteria Guideline for transgender medical care services, and (3) efforts to institute data collection on the basis of sexual orientation and gender identity.
HCFANY’s LGBT Task Force is working hard on many of these same issues at the state level. The Task Force has provided LGBT cultural competency training to more than 150 Navigators across the state so they can better serve LGBT people who want to apply for coverage. The Task Force also advocated for issuance of state policies requiring coverage of medically-necessary care that transgender people need by both private insurance and Medicaid. Listening sessions have been helping the Task Force and state officials identify needed follow up action to ensure compliance with these transgender coverage policies.
Want to learn more about coverage for yourself or an LGBT loved one? Contact the Community Health Advocates hotline at 888-614-5400, or visit the NY State of Health website to learn about your coverage options, which include the new very low-cost Essential Plan.
The December 15th deadline to enroll in health insurance starting January 1, 2016 is fast approaching. To make sure you don’t have a gap in coverage, log on to the New York State of Health Marketplace today! You can shop around and compare plans to see which is right for you and your family.
If you need help enrolling or renewing your coverage you can call the Community Health Advocates helpline at 1-888-614-5400, or visit an in-person assistor in your community.
You may be eligible for the new Essential Plan, which includes high quality coverage for $0 or $20 per person per month. There’s no deductible, very low copays, and optional vision and dental coverage too. Many low- and middle-income New Yorkers between the ages of 19 and 64 will qualify.
If your New Year’s resolution includes getting or staying healthy, don’t wait to enroll! It will also help you avoid the tax penalty, which is rising to 2.5% of your family’s yearly taxable income or $695 per person (whichever is higher) this year.
The health insurance enrollment process can be overwhelming. Take a look at these entertaining videos on health insurance literacy for navigators, assistors, and consumers brought to you by Cover Missouri, a project of the Missouri Foundation for Health (MFH). They touch upon major issues and questions that you may encounter during the application process such as what questions to ask when you are on the phone with your carrier, common misconceptions of the Affordable Care Act, and how to find a primary care provider.
Check them out on YouTube: