The Procrastinator's Guide to Health Reform's Individual Mandate

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Do you simply not want to deal with U.S. health reform? This guide is for you and explains what the individual mandate means to you.

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The Procrastinator's Guide to Health Reform's Individual Mandate

  1. 1. The Procrastinator's Guide to Health Reform’s Individual Mandate
  2. 2. Legal stuff Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues. The following is a brief overview only (as of September 2013). Photo Credits: BigStock Photo
  3. 3. What is the individual mandate?
  4. 4. A provision of health reform’s
  5. 5. Requires most people to have a minimum amount of health insurance coverage The individual mandate
  6. 6. 3.5 Million + Any exceptions?
  7. 7. 3.5 Million + YES – THERE ARE A FEW EXCEPTIONS
  8. 8. Exceptions If you don’t have to file a tax return because you don’t make enough money* *According to the IRS guidelines
  9. 9. You can’t afford to buy insurance
  10. 10. NO, THAT’S NOT UP TO YOU The IRS defines that as coverage that costs more than 8% of your household income You can’t afford to buy insurance
  11. 11. Indian Tribes * Certain religious sects* People who are in prison Undocumented immigrants *Federally-recognized Other exceptions
  12. 12. Where can you buy insurance?
  13. 13. 3.5 Million + Your employer (if they offer it)
  14. 14. 3.5 Million + Your employer (if they offer it) Your state’s health insurance marketplace (Exchange)
  15. 15. 3.5 Million + A government program (if you qualify) Other plans
  16. 16. 3.5 Million + A government program (if you qualify) Directly from an insurance company or broker Other plans
  17. 17. 3.5 Million + What if you still can’t afford it? If insurance costs less than 8% of your household income
  18. 18. 3.5 Million + What if you still can’t afford it? If insurance costs less than 8% of your household income BUT, YOU STILL CANNOT AFFORD IT – YOU MAY BE ELIGIBLE FOR HELP (A SUBSIDY) PAYING YOUR PREMIUM
  19. 19. Who is eligible for help? Middle & low income individuals may be eligible
  20. 20. Who is eligible for help? 2013 ESTIMATES Individuals earning $45,960 (or less) A family of four $94,200 (or less) ESTIMATES BY FAMILYUSA
  21. 21. What if you don’t purchase insurance?
  22. 22. There is a tax penalty
  23. 23. THE FLAT DOLLAR AMOUNT $95 $47.50 $325 $162.50 $695 $347.50 PER ADULT PER CHILD 2014 2015 2016 You pay the higher of
  24. 24. THE FLAT DOLLAR AMOUNT $95 $47.50 $325 $162.50 $695 $347.50 PER ADULT PER CHILD 2014 2015 2016 You pay the higher of
  25. 25. OR THE % OF FAMILY INCOME $95 $47.50 $325 $162.50 $695 $347.50 PER ADULT PER CHILD 2014 2015 2016
  26. 26. OR THE % OF FAMILY INCOME $95 $47.50 $325 $162.50 $695 $347.50 PER ADULT PER CHILD 2014 2015 2016 1% OF FAMILY INCOME IN 2014 – 2% IN 2015 – 2.5% IN 2016
  27. 27. 3.5 Million + Is your current coverage ok? Probably – but check with your employer or insurance agent IF YOU’RE COVERED BY MEDICARE OR MEDICAID, YOU HAVE THE REQUIRED COVERAGE
  28. 28. Other approved coverage Plans from your state insurance marketplace
  29. 29. Other approved coverage Plans from your state insurance marketplace Other government programs CHECK HEALTHCARE.GOV
  30. 30. What if you lose your coverage?
  31. 31. You are allowed 3 months or less for lapsed coverage
  32. 32. You are allowed 3 months or less for lapsed coverage AFTER THAT, YOU ARE SUBJECT TO THE TAX PENALTY
  33. 33. Do you have to cover dependents?
  34. 34. YES
  35. 35. YES If they qualify as dependents under the IRS Code
  36. 36. YES If they qualify as dependents under the IRS Code IT GETS TRICKY WITH CUSTODIAL VERSUS NON-CUSTODIAL PARENTS SO CHECK WITH YOUR TAX CONSULTANT IF THIS APPLIES
  37. 37. When does the mandate start?
  38. 38. Open enrollment for state insurance marketplace starts October 1, 2013 CHECK HEALTHCARE.GOV FOR DETAILS IN YOUR STATE
  39. 39. What’s your next steps?
  40. 40. CHECK REQUIREMENT • Are you required to have coverage? • Are you excluded from the requirement? CHECK OPTIONS • Employer coverage? • Government program? • Buy your own? CHECK FINANCIAL HELP • Are you eligible for premium help? • If employer coverage, any incentives to lower your cost?
  41. 41. Helpful Resources HealthCare.Gov Subsidy calculator at Kaiser Family Foundation KFF.org
  42. 42. Cathy Miller, Business Writer Business site: www.SimplyStatedBusiness.com Want more health care information? Visit my health care blog at www.SimplyStatedHealthCare.com

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