It’s decision time.
If you don’t have a healthcare plan, you need to get one by January 31 or face a significant fine – $695 minimum per adult (up from $325 in 2015) $347.50 per child, or 2.5% of your household income -whichever is greater – up to a maximum of $2,085 if you’re uninsured for 12 months.
There are, however, long lists of exemptions that enable you to avoid paying a fine if you experienced financial or personal hardships, live in a state that makes it hard to get coverage, or aren’t required to have coverage due to life circumstances. For example, if you’re a Native American, are living abroad, are incarcerated or have religious objections to health insurance – you probably won’t have to pay a fine for not having coverage.
Qualifying for an exemption also enables you to purchase a “catastrophic” policy, if you choose to do so. These policies are intended to help you pay for worst-case health scenarios, like getting seriously sick or injured. The deductible on these plans is $6,850, so you’ll be paying for virtually all basic medical expenses out of pocket. Catastrophic plans were all but removed from the private insurance market due to the Affordable Care Act’s requirements that insurance provide coverage for preventive and other essential care. You need to get a certificate – which you will receive if you are granted an exemption – to purchase a catastrophic plan.
Exemptions have not yet been released for the 2016 tax year, but aren’t expected to vary much from the 2015 list. The exemptions are:
- The lowest-priced coverage available to you, through either a Marketplace or job-based plan, would cost more than 8.05% of your household income
- You don’t have to file a tax return because your income is below the level that requires you to file
- You were uninsured for no more than 2 consecutive months of the year
- You lived in a state that didn’t expand its Medicaid program but you would have qualified if it had
- You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
- You’re a member of a recognized health care sharing ministry
- You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
- You’re incarcerated (serving a term in prison or jail)
- You’re a U.S. citizen living abroad
You can file for exemptions for all of the conditions listed above here.
You may also qualify for an exemption if you have experienced what the government considers a hardship, which can range from financial issues to family and work problems. The list of hardship exemptions includes:
- You were homeless
- You were evicted or were facing eviction or foreclosure
- You received a shut-off notice from a utility company
- You experienced domestic violence
- You experienced the death of a family member
- You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property
- You filed for bankruptcy
- You had medical expenses you couldn’t pay that resulted in substantial debt
- You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member
- You expect to claim a child as a tax dependent who’s been denied coverage for Medicaid and CHIP for 2015, and another person is required by court order to give medical support to the child. In this case you don’t have to pay the penalty for the child.
- You won an eligibility appeals decision regarding an Obamacare plan
- You would have qualified for Medicaid but your state didn’t expand eligibility for Medicaid in 2015.
- Your individual insurance plan was cancelled after June 30, 2013 and you believe other Marketplace plans are unaffordable
The last exception may enable a significant number of people to claim an exemption. About half of all uninsured Americans have said they did not buy Obamacare health insurance plans because the premium costs and deductibles are too high, according to the Kaiser Family Foundation Health Tracking poll.
If you are struggling to balance your budget and healthcare costs, dental savings plans are a great option. You can save 10%-60% on dental services, at thousands of dentists’ offices nationwide. And if your Marketplace plan’s deductible requires you to pay thousands out of pocket before coverage kicks in, consider a telehealth plan. The telehealth plans available through dentalplans.com offer free (yes, free) consultations with local doctors, 24/7. Doctors can diagnose common illnesses and ailments, and can prescribe medication as needed.
Note that these plans are not Obamacare qualified insurance. Dental savings plans and :DP telehealth plans are alternatives to standard insurance that help you get the quality care you need at a price that you can afford.