The individual mandate within the Affordable Care Act requires that beginning in 2014, individuals are required to have health insurance or pay a fine. But what if you can’t afford to buy coverage? As we have seen in the news the last few weeks, even the least expensive plans could be costly, particularly for those who have not had health coverage before.
The government may provide financial assistance (subsidies) to help some people pay for coverage if they can’t afford to pay for it. Whether or not you qualify for financial assistance will be determined by your income level and family size.
In New Hampshire, individuals who make up to $45,960 and families who make up to $94,200 (for a family of four) may be eligible for premium assistance.
You can find out if you are eligible for subsidies through the Health Insurance Marketplace, or we can help you determine what, if any, federal financial assistance you are eligible for. If you are not eligible for subsidies, there will be other ways to help you cut costs.
Economic Hardship Exemption
If the least expensive option on the insurance exchange would cost more than 8% of your annual income, you can be exempted from the penalty for not having coverage. In these cases you could still buy a catastrophic plan that provides low premiums in exchange for high deductibles and coverage for only major medical expenses. These catastrophic plans are only available to those who have qualified for an economic hardship exemption or are under age 30.
Federal Tax Subsidies
Financial assistance in the form of subsidies, or federal tax credits, will be available for those whose income is between 100% and 400% of the federal poverty level. These subsidies are only available for those who purchase plans on the insurance exchange—not if you purchase a plan privately through an insurance company. When you enroll in a health plan through the New Hampshire Health Insurance Exchange—via Healthcare.gov—any tax credits you qualify for will be immediately applied to your insurance premium, reducing the amount you will pay each month. Tax credits will be available to anyone who qualifies for them, whether or not they file taxes.
Medicaid or CHIP
You may qualify for Medicaid or your children may qualify for the Children’s Health Insurance Program (CHIP) in 2014, even if you have been turned down in the past. If you are eligible for Medicaid or CHIP, you or your children will get free or low-cost health care. When you apply for coverage at Healthcare.gov, the state will check your application against the new eligibility rules and tell you whether you qualify for Medicaid or any other savings options.
Cost-Sharing Subsidies
You might also be eligible for cost-sharing subsidies in the form of reduced copayments or coinsurance that reduce the amount you pay when you get care. Reduced copayments or coinsurance lower the total amount you have to pay for health care in a given year, and will vary depending on the type of plan you choose (Platinum, Gold, Silver, or Bronze). Eligibility for these subsidies is based on your income level and family size.
Do you need to purchase health coverage for yourself or your family? Have you started looking at your options? Do you know if you will be eligible for financial assistance of any kind? We can help you navigate the complex system, provide advice and help you determine if you are eligible for any subsidies or other financial help. If you do not qualify for financial assistance, we work with several health insurance companies, and we can help you find the best plan to fit your needs and budget.
