Happy Holidays from Georgians for a Healthy Future and GEAR
Congratulations on making it past the December 15th deadline (which really turned out to be the December 17th deadline)! We know it has been a crazy few days for all of the enrollment assisters, so we wanted to spread some holiday cheer. Watch our video below!
Five Facts for Consumers about the Fee for Not Having Health Coverage
No one likes to talk about the fee for not having health insurance, but since the 2016 penalty will be so large, it’s going to be a major motivator for consumer’s (Pro tip: Use the term “fee” instead of “penalty” – it resonates better with consumers).
Here are 5 facts about the fee that consumers need to know:
- The fee is calculated 2 ways, depending on the consumers situation – If a consumer goes for more than three months without coverage despite having access to affordable coverage (from their job, the Marketplace, Medicaid, Medicare, or purchased on their own) they will have to pay a fee of 2.5% of their annual income or $695 dollars. They will have to pay whichever is they higher of those two amounts, and for most it will be 2.5% of their annual income.
- The fee for 2016 is increasing – as noted above. Some consumers that were on the fence about enrolling the first two years decided to take the fee because it was more affordable than enrolling in coverage. That is not likely going to be the case this year because the fee is so much larger.
- Every month without coverage counts – The fee is calculated based on the number of months (over 3) that you went without coverage, up to the maximum fee.
- Some people can get an exemption from the fee – people that are unable to get a subsidy because their income is too low are exempt from the fee. Also exempt are people that are not legally in the country, people in jail, and people that went less than 3 months without coverage. Click here for the exemption tool from healthcare.gov.
- If they want to avoid the fee, they need to enroll by January 31st, 2016 – CMS has released a statement that the deadline will not be extended and the SEP that was available for the April 15th tax deadline will not be available this year. So make sure your consumers know that January 31st is the LAST DAY TO ENROLL!
Important note: the maximum fee a consumer will have to pay is capped at the total yearly premium for the national average price of a Bronze plan sold through the Marketplace.
Source: CMS Blog
Resource Highlights: Hard Copies of the Spanish Enrollment Toolkit and Health Insurance User’s Manual
We have hard copies of our Spanish version of the Enrollment Toolkit Health Insurance User’s Manual. We have a limited amount of hard copies, but the electronic versions are available on the GEAR website. Email Whitney if you are interested in receiving hard copies.
Penalties and Exemption Fact Sheet
Speaking of the fee, need help explaining the fee to consumers? Or want to walk someone through whether or not they will need to pay the fee? Check out GHF’s “Penalties and Exemptions” tool.
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