1 What You Need to Know about Health Insurance What You Need to Know about Health Insurance Choosing a Health Plan Applying for Health Insurance Title What Here to Do Title if You Here Are Title Uninsured Here Title Here Title Here after Title March Here 31, Title 2014Here Title Here About this fact sheet If you don t have health insurance now, you may still be able to get it. If you can t, there are ways that you can get basic health care services to help you stay healthy. There are also important things you need to know about the requirement to have health insurance and whether you will have to pay a penalty for being uninsured. Applying for Coverage between March 31 and November 15, 2014 Some People Can Get Insurance through Medicaid or CHIP There are several groups of people who may be able to get coverage through Medicaid or the Children s Health Insurance Program (which is also called CHIP). This includes people who: are under age 19 were in foster care at age 18 are pregnant are a parent and have children under age 19 have a disability or are over age 65 are adults with low incomes in states that have expanded Medicaid If you are in one of these groups, you can apply through the marketplace or through your state s Medicaid or CHIP agency. Even if you think you can t get Medicaid, you should apply for it anyway. If you are denied Medicaid because your state has not expanded its Medicaid program, it means you don t have to pay a penalty for being uninsured. It also means you may be able to get financial assistance to buy a health plan in the marketplace later in the year if you qualify based on your income. If that happens, you will not have to pay a penalty for the months of the year when you were uninsured.
2 Medicaid and CHIP Enrollment Are Open All Year You can apply for Medicaid at any time during the year through your state Medicaid agency or the marketplace. Medicaid coverage is based on income and family size. This table applies only to states that have expanded Medicaid for adults. Find your family size in the table below to see if you might qualify. Children can get coverage through CHIP even if their family income is higher than the amounts listed in the table. Number of People in Your Household Household Income $16,105 $21,707 $27,310 $32,913 $38,516 $44,119 Marketplace Enrollment Is Open When Your Life Changes You can sign up for marketplace health insurance if you experience certain life events that give you a special enrollment period. If you experience one of these events, you will have 60 days from the date of the event to enroll in health insurance: Getting married Permanently moving to a new area in the state or country that offers different health plan options Losing other health coverage (for example, because you lost your job, got divorced, lost Medicaid, your COBRA ran out, your health plan was decertified, or you lost coverage under a parent s plan) Gaining a dependent or becoming a dependent through birth, adoption, placement for adoption, or placement in foster care Becoming a citizen, a national, or a lawfully present resident Leaving prison, jail, or a correctional facility No longer qualifying for an exemption from the penalty for not having insurance 2 WHAT YOU NEED TO KNOW ABOUT HEALTH INSURANCE
3 Apply for Health Insurance that Starts on January 1, 2015 The next open enrollment period to apply for marketplace health insurance begins on November 15, If you do not qualify for a special enrollment period: You can apply for health insurance between now and December 15, 2014, and you will be able to get insurance that starts on January 1, You can apply before November 15, 2014, and you will receive information about whether you can get financial assistance to help pay for a marketplace health plan, but you will need to wait until November 15 to choose a plan. If You Stay Uninsured in 2014 You May Pay a Penalty on Your 2014 Tax Return If You Cannot Get an Exemption Starting this year, most people must have health insurance, or they will pay a penalty on their federal taxes. But some people are exempt from this requirement (meaning this requirement does not apply to them). You can get an exemption if you: Would have to pay more than 8 percent of your household income for insurance Are eligible for services through an American Indian health care provider Belong to a religious sect that is opposed to insurance Can t get health insurance because your state has not expanded Medicaid Have a hardship (such as an unexpected increase in expenses, if buying health insurance would prevent you from paying for other necessities, or if you have other difficult circumstances) Your private insurance plan is cancelled and you can t afford other insurance Call the Marketplace Call Center at (TTY: ) or go online and print out an exemption form at https://www.healthcare.gov/exemptions/. If you get an exemption because your state did not expand Medicaid or because of a financial hardship, tell the marketplace if your income or the number of people in your family increases during the year, or if you are no longer experiencing a financial hardship. 3
4 You can also apply for an exemption when you file taxes for the 2014 tax year if you: Went without health insurance for less than three months in a row during 2014 Have an income that is low enough that you don t have to file taxes (even if you file to get a refund) Are in jail or prison after a conviction Are a member of a recognized health care sharing ministry Belong to a federally recognized American Indian or Alaska Native tribe How much is the penalty in 2014? The amount you pay if you or your dependents do not have insurance is the higher of: 1 percent of the income your household makes above the tax filing threshold (your tax filing threshold is based on your filing status), not including Social Security income (The maximum amount you would pay depends on the cost of certain plans in the marketplace.) OR $95 for each adult and $47.50 for each child, up to a maximum of $285 for a family If you re insured for part of the year, you ll have to pay 1/12 th of the yearly penalty for each month that you re uninsured. Any penalties you owe will be collected on your 2014 federal income tax return. These penalty amounts will go up in Additional Resources Getting Health Care If you cannot afford to buy health insurance, you can still get basic health care services at a health center to help you stay healthy. You can find a health center near you by calling the Health Resources and Services Administration at , or by using the search tool online at hrsa.gov/search_hcc.aspx. If you need help getting health care services that are not provided by a health center, call the Patient Advocate Foundation at Getting Assistance with Health Care Costs You may be able to get assistance with paying for prescription drugs and other health care services for specific conditions. If you need help with paying for prescription drugs, call NeedyMeds at , or go online at 4 WHAT YOU NEED TO KNOW ABOUT HEALTH INSURANCE
5 The complete What You Need to Know about Health Insurance series: Applying for Health Insurance Applying for a Marketplace Plan if You Can Get Health Insurance through Your Job What to Do if You Are Uninsured after March 31, 2014 Getting Financial Assistance Getting Financial Assistance to Pay for Health Insurance Deciding How Much Financial Assistance to Use to Lower Your Monthly Premiums How Getting Financial Assistance to Pay for Health Insurance Affects Your Taxes Getting Extra Financial Assistance to Help Pay Health Care Costs Choosing a Health Plan Choosing the Health Plan that s Right for You Choosing a Health Plan You Can Afford Understanding the Differences between Platinum, Gold, Silver, and Bronze Plans Understanding Catastrophic Health Insurance Buying Children s Dental Coverage through the Marketplace Keeping and Using Health Insurance How to Use Your Health Insurance How to Keep Your Marketplace Health Insurance What to Do after You Buy Health Insurance in the Marketplace Understanding the Requirement to Have Health Insurance Understanding the Requirement to Have Health Insurance Understanding Minimum Essential Coverage Reference Charts and Graphics Income Guidelines for Getting and Using Financial Assistance for Health Insurance Income Guidelines for Getting Extra Financial Assistance to Pay for Health Care Costs Types of Exemptions from the Requirement to Have Health Insurance A complete list of Families USA publications is available online at PUBLICATION ID: 020NAV New York Avenue NW, Suite 1100 Washington, DC Families USA 2013
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