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Thursday, March 24, 2016

Ask a Navigator: How is health insurance changing in 2016 and 2017?

Question #1: How big are the fines?
The fine for being uninsured is much bigger in 2016. 
As a certain orange-tinted presidential candidate might say, the fine is “HUUUGGGGE!”
The annual fine can be calculated two ways: 1) On a per-person basis, or 2) Based on overall household income. When you calculate your 2016 taxes next year, you’ll pay whichever fine is higher if you remained uninsured for more than three months. And keep in mind the fine is pro-rated based on the number of months you lacked insurance (i.e. you’ll only pay the fine for the months you lacked health insurance).
Here’s how the annual fine is calculated:


  • The per-person fine is $695 per adult, $347.50 per child, up to a maximum of $2,085 per family.
  • The income fine is 2.5% of your household income minus the filing threshold (ie. $10,000 per individual, $20,000 per family). So if a family makes $60,000 a year, their fine would be 2.5% x $40,000 or $1,000.
  • Earlier this year the brainiacs at the Kaiser Family Foundation calculated that the average family fine would be $969 for 2016.

Before you get your undies in a bundie, remember that many people are exempt from the fine. A recent analysis by TurboTax estimated that 70% of the uninsured qualified for an exemption in 2015. The biggest group exempted from the fine are those who live in the Medicaid coverage gap because they earn below 100% of the federal poverty level and can’t qualify for premium subsidies on the health insurance marketplace. Other exemptions are designed for people who experience a death in the family, eviction, utility shutoffs, medical emergencies, or natural disasters. For a complete list of hardship exemptions, go here. For more information on fines and the exemption, contact an expert enrollment assister at Take Care Utah or call 2-1-1.

Question #2:  When can I sign up for insurance?
We are now in a Special Enrollment Period (SEP), which means you need to experience a “Qualifying Life Event” to trigger a 60-day window to purchase health insurance. These life events including getting married or divorced, having or adopting a child, turning age 26 and leaving your parent’s insurance, moving (even within a state), losing health insurance due to job termination or a schedule change, gaining U.S. citizenship, or being released from incarceration. See Take Care Utah’s handy one-page chart on SEPs here (pdf).
The next open enrollment period—the time when you don’t need a qualifying life event to sign up cover coverage—will begin November 1, 2016 and end January 31, 2017. In subsequent years we’ve learned that the open enrollment period will shrink to 45 days and last from November 1 to December 15. Given how many people signed up for health insurance in the last two weeks of January this year, we are not looking forward to that shortened enrollment period. And remember that enrollment for Medicaid and CHIP is open year-round. Get answers to all of your health insurance and enrollment questions by contacting an enrollment expert at Take Care Utah or call 2-1-1.

Question #3: Will there be more coverage options for rural Utahns in next year?
The collapse of Arches Health Plans last October left 20 of Utah’s 29 counties with only one insurer—SelectHealth—offering plans on the insurance marketplace. While this lack of competition didn’t impact rates in 2016, it could drive up rates next year if more insurers don’t enter those regions and a monopoly develops. Fortunately, we’ve heard that one or two existing Utah insurers are interested in offering plans in these 20 mostly rural counties. As a result, we expect more insurers and more plans to fill the Utah insurance marketplace in 2017. But no matter where you live, from Moab to Brigham City and from Hurricane to Kanab, health insurance enrollment experts are ready to help you by phone or in person. Find your nearest expert by going to Take Care Utah or the web or calling 2-1-1.

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