the procrastinator's guide to health reform's individual mandate
DESCRIPTION
Do you simply not want to deal with U.S. health reform? This guide is for you and explains what the individual mandate means to you.TRANSCRIPT
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The Procrastinator's Guide to Health Reform’s Individual Mandate
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Legal stuff
Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues. The following is a brief overview only (as of September 2013). Photo Credits: BigStock Photo
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What is the individual mandate?
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A provision of health reform’s
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Requires most people to have a minimum amount of health
insurance coverage
The individual mandate
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3.5 Million +
Any exceptions?
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3.5 Million +
YES – THERE ARE A FEW EXCEPTIONS
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Exceptions
If you don’t have to file a tax return because you don’t make enough money*
*According to the IRS guidelines
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You can’t afford to buy insurance
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NO, THAT’S NOT UP TO YOU
The IRS defines that as coverage that costs more than 8% of your household income
You can’t afford to buy insurance
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Indian Tribes *
Certain religious sects*
People who are in prison
Undocumented immigrants
*Federally-recognized
Other exceptions
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Where can you buy insurance?
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3.5 Million +
Your employer (if they offer it)
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3.5 Million +
Your employer (if they offer it)
Your state’s health insurance marketplace
(Exchange)
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3.5 Million +
A government program
(if you qualify)
Other plans
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3.5 Million +
A government program
(if you qualify)
Directly from an insurance company
or broker
Other plans
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3.5 Million +
What if you still can’t afford it?
If insurance costs less than 8% of your
household income
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3.5 Million +
What if you still can’t afford it?
If insurance costs less than 8% of your
household income
BUT, YOU STILL CANNOT AFFORD IT – YOU MAY BE ELIGIBLE FOR HELP (A SUBSIDY) PAYING
YOUR PREMIUM
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Who is eligible for help?
Middle & low income individuals may be eligible
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Who is eligible for help?
2013 ESTIMATES
Individuals earning $45,960 (or less)
A family of four $94,200 (or less)
ESTIMATES BY FAMILYUSA
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What if you don’t purchase insurance?
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There is a tax penalty
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THE FLAT DOLLAR AMOUNT
$95 $47.50 $325
$162.50 $695
$347.50
PER ADULT PER CHILD
2014 2015 2016
You pay the higher of
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THE FLAT DOLLAR AMOUNT
$95 $47.50 $325
$162.50 $695
$347.50
PER ADULT PER CHILD
2014 2015 2016
You pay the higher of
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OR THE % OF FAMILY INCOME
$95 $47.50 $325
$162.50 $695
$347.50
PER ADULT PER CHILD
2014 2015 2016
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OR THE % OF FAMILY INCOME
$95 $47.50 $325
$162.50 $695
$347.50
PER ADULT PER CHILD
2014 2015 2016
1% OF FAMILY INCOME IN 2014 – 2% IN 2015 – 2.5% IN 2016
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3.5 Million +
Is your current coverage ok?
Probably – but check with your employer or insurance agent
IF YOU’RE COVERED BY MEDICARE OR MEDICAID, YOU HAVE THE REQUIRED COVERAGE
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Other approved coverage
Plans from your state insurance marketplace
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Other approved coverage
Plans from your state insurance marketplace
Other government programs
CHECK HEALTHCARE.GOV
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What if you lose your coverage?
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You are allowed 3 months or less for lapsed coverage
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You are allowed 3 months or less for lapsed coverage
AFTER THAT, YOU ARE SUBJECT TO THE TAX PENALTY
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Do you have to cover dependents?
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YES
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YES
If they qualify as dependents under the IRS Code
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YES
If they qualify as dependents under the IRS Code
IT GETS TRICKY WITH CUSTODIAL VERSUS NON-CUSTODIAL PARENTS SO CHECK WITH
YOUR TAX CONSULTANT IF THIS APPLIES
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When does the mandate start?
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Open enrollment
for state insurance marketplace starts October 1, 2013
CHECK HEALTHCARE.GOV FOR DETAILS IN YOUR STATE
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What’s your next steps?
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CHECK REQUIREMENT
• Are you required to have coverage?
• Are you excluded from the requirement?
CHECK OPTIONS
• Employer coverage?
• Government program?
• Buy your own?
CHECK FINANCIAL HELP
• Are you eligible for premium help?
• If employer coverage, any incentives to lower your cost?
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Helpful Resources
HealthCare.Gov
Subsidy calculator at Kaiser Family Foundation KFF.org
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Cathy Miller, Business Writer
Business site:
www.SimplyStatedBusiness.com
Want more health care information? Visit my health care blog at
www.SimplyStatedHealthCare.com