Tuesday, November 05, 2013

Obamacare Features

Here is information directly from Healthcare.Gov about the "individual shared responsibility fee" and the least expensive "Catastrophic Plan" (not available to everyone).
If you can afford health insurance but choose not to buy it, you must pay a fee known as the individual shared responsibility payment.

The fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher. [underlining added]

In 2014 the payment for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285. [Extrapolated for 2016, the most a family would have to pay is $2085.]
If a person wanted to buy the least expensive policy to avoid the penalty fee, a person must be either young or exempt from the penalty altogether.
In the Marketplace, catastrophic plans are available only to people under 30 and to some low-income people who are exempt from paying the fee because other insurance is considered unaffordable or because they have received "hardship exemptions". Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost. After the deductible is met, they cover the same set of essential health benefits that other Marketplace plans offer. People with catastrophic plans are not eligible for lower costs on their monthly premiums or out-of-pocket costs. [underlining added]

The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
The website discusses who is exempt from paying the penalty but also lists "hardship exemptions" which could apply to anyone if the right cards were played.
If you have any of the circumstances below that affect your ability to purchase health insurance coverage, you may qualify for a "hardship" exemption:

1) You were homeless.

2) You were evicted in the past 6 months or were facing eviction or foreclosure.

3) You received a shut-off notice from a utility company.

4) You recently experienced domestic violence.

5) You recently experienced the death of a close family member.

6) You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.

7) You filed for bankruptcy in the last 6 months.

8) You had medical expenses you couldn’t pay in the last 24 months.

9) You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.

10) You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the (sic) pay the penalty for the child.

11) As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.

12) You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
Recent reports indicate that Medicare fraud is rampant. It is anticipated that Obamacare fraud will be even greater.

The "Glossary" will link to most of the information on Healthcare.Gov.

Posted by Note Taker

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