Q&A: Can’t afford health plan, will I be fined?

  • Posted: Friday, March 21, 2014 3:19 p.m.
AP Photo/Jon Elswick, File
This March 1 photo shows part of the website for HealthCare.gov as photographed in Washington, D.C. The new health care law helps some people, hurts others and confuses almost everyone.
AP Photo/Jon Elswick, File This March 1 photo shows part of the website for HealthCare.gov as photographed in Washington, D.C. The new health care law helps some people, hurts others and confuses almost everyone.

Associated Press

WASHINGTON, D.C. ó The new health care law helps some people, hurts others and confuses almost everyone. Hoping to simplify things a bit, The Associated Press asked its Twitter, Facebook and Google Plus followers for their real-life questions about the program and the problems theyíre running into as the March 31 deadline approaches to sign up for coverage in new insurance markets.

Two of their questions and our answers:

CAN THEY FINE ME?

Q: ďIím currently unemployed and without health insurance. How does this affect me at this time? ... Iíll be fined because I canít afford coverage?Ē Ė Cat Moncure, Harrisonburg, Va.

A: As long as you donít have income, the government doesnít require you to get health coverage and wonít fine you. Specifically, if you donít make enough money so that you have to file a federal tax form, youíre in the clear from the lawís insurance mandate. The tax-filing threshold is $10,000 for an individual, $20,000 for a family.

But letís say you get a job this year and earn enough so that you have to file a 2014 tax form. Then youíll have to do some math to see whether you have come under the requirement to get health insurance.

If the cheapest policy you can get costs more than 8 percent of your income, you still donít need health insurance. In that case, youíll get an exemption from the coverage requirement when you file your taxes. If you make more than that, then you will need coverage or face an IRS penalty.

Of course, none of this helps you get health care if you need to see a doctor while you are jobless.

In some states, Medicaid is the answer because theyíve expanded the program to low-income adults without children, not just families, children or certain disabled or elderly adults. But Virginia did not expand its program. The new Virginia governor, Terry McAuliffe, has made Medicaid expansion a priority. But thereís no telling how long that might take or whether heíll succeed.

Itís probably worthwhile to go to HealthCare.gov, click on ďsee plans before I applyĒ and follow the steps to find out what plans are available in your area, what they cost and what kind of subsidy you might get if you purchase one in that marketplace. You donít lose anything by window shopping.

Whatever you do, know that if you get a job during 2014, your new income may require you to get insurance at that time. Youíll want to keep an eye on that, so you donít find yourself facing a penalty when you file 2014 taxes.

TRAPPED IN WORKPLACE PLAN?

Q: ďMy insurance went up. Now, I have no $$ left to actually afford the copays or the much needed eyeglasses for my daughter. I think Iím what Obamacare considers the working poor. I work, therefore I donít get free health care. Like everything else offered to help struggling people, I make less than $200 over the minimum, so I get zilch.Ē Ė Laura Carter, suburbs of Savannah, Ga.

Her story: Carter supports an 18-year-old daughter and herself with a $27,000 salary from her job as a mitigation specialist and collector in Savannah, 45 minutes from her home. When her company changed insurers in October, her premiums for family coverage soared by about $150 a month, to $285.

A: People like Carter, who feels stuck in a workplace plan she canít afford, may qualify for subsidized coverage in the new insurance markets, called exchanges, under certain conditions.

The exchanges are mostly for people who do not get insurance at work. But they are also open to those who get work-based insurance that costs too much. The rule is this: If you are paying more than 9.5 percent of your income for your employerís insurance, you should be able to switch to a plan in the exchange, and if your income is low enough, you should qualify for subsidized premiums in that plan.

It gets a bit more complicated when your work coverage extends to a family member, like Carterís daughter. In Carterís case, she has to ask her employer how much insurance would cost her if only she were covered. If itís more than 9.5 percent of her income, she meets the test. Then she and her daughter should be able to move to a plan in the exchange. Based on her income, she should be able to find considerably cheaper coverage there.

In a family with adult children under 26, it may also be worth seeing how much separate policies would cost for parent and child, and whether the child might qualify for Medicaid coverage. These options are much more promising when the child is no longer a dependent on the parentís taxes. Also, Medicaid might only be an option in states that expanded the program. Georgia, for one, didnít.

Under the law, children up to 26 can stay on their familyís coverage, so thereís no need to split it up if it doesnít save money.

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Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

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Do you have your own questions about how the U.S. health care law affects you? Ask AP using the (hash)APHealthCare hashtag on Twitter or by commenting under our Facebook or Google Plus posts on the topic:

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