Tag Archives: compliance

How Children & Graduates Can Stay Compliant With Obamacare

Obamacare Graduates Children & health insurance
Photo by Russ Allison

If you’re a forthcoming graduate, getting off your parents’ health insurance soon, or moving out of your home state after college, you’re probably wondering what your responsibility is about health insurance in the light of the Affordable Care Act. Avoid wasting money paying the fine you’d incur by going without health insurance. Here are some key questions and answers that can help.

A few definitions/acronyms to know:
ACA – Affordable Care Act
ESI – Employer sponsored insurance. NOTE: Most offers of employer healthcare coverage are affordable and adequate, as defined by the ACA. Affordable employer insurance is defined as “less than or equal to 9.5% of the household income for self-only coverage.” (The cost of adding a spouse and children is not included.) Adequacy is determined by minimum value standards.
MECMinimum essential coverage • See what counts as MEC
SEPSpecial enrollment period – a time outside of open enrollment when you have an opportunity to sign up for health insurance

How long can I stay on my parents health insurance? Until you turn 26—even if you have an offer of insurance through your spouse or employer.

If I move out of their home or out of state, can I still stay on their insurance, and if so, to what age? Graduating or moving out of your parents’ home doesn’t necessarily count as a qualifying life event (also referred to as a triggering event.) You can stay on their insurance until you’re 26 (or enroll in ESI if that is available to you.)

I don’t live with my parents, and I’m not on their health insurance. At what age am I responsible to have my own health insurance? Essentially, it’s not about age. In the event a child is fined, the tax filer (either a parent or other) is responsible for paying the fine. If you are a tax filer, you will be asked about having health insurance when you file taxes, and if you could have afforded health insurance and went without it, then you or whoever is the tax filer will be fined. If you did not have an affordable offer of health insurance and went without it, then you qualify for a hardship exemption. Ideally if you are working and qualify for ESI, you must enroll in that.

What are the timeframes for an SEP and the fine? You can apply for ACA insurance up to 60 days before your qualifying life event. Then you’ll have 60 days after your qualifying life event as your SEP to enroll in a healthcare.gov Marketplace plan or secure other health insurance. Remember, if you go 3 months or more in a calendar year with no health insurance, you will probably incur a fine when you file your annual Federal taxes. The sooner you can get on top of this after you know you will not have coverage, the better so you can avoid the fine and/or having to wait until the next year for open enrollment to secure a Marketplace plan.

Anything else I should know? If you have affordable and adequate insurance available to you through either your parents’ policy or through your job, you will not get tax credits (a discount on the plan) on a Marketplace plan if you apply for one. Knowing when your current coverage will end and if you have another offer of affordable coverage available to you will help as you choose new health insurance.

For more information: See https://www.healthcare.gov/sitemap or call 1-800-318-2596. Find local help through people and organizations in your community who can help you apply, enroll, and answer your questions. Also, this Reference Chart will provide more information about events that can allow/begin an SEP.

Thanks again to Rachel Clifton at the Tennessee Justice Center for help with the information in this article.

Don’t miss a thing. Subscribe to receive updates by email.
Looking for a new job? Want to get the one you want faster? Check out my new book, Here Today, Hired Tomorrow.

4 Things You Should Know About Job Loss & Staying Obamacare Compliant

obamacare, health insurance, compliant
Photo by Brooke DiDonato

NOTE: All information herein is still current, just note that as of the tax year beginning January 2019 individuals will no longer incur a penalty for not having health insurance.

As you know, the Affordable Care Act requires everyone to have health insurance or a compliant health coverage option. Also known as Obamacare, the ACA was signed into law on March 23, 2010 and enforcement began in January of 2014. The amount of the fine (assessed when you file your annual Federal taxes) is determined by when a person’s work-provided insurance is lost, one’s household income, and one’s amount of time without coverage. But just to give you an idea, by 2016, the fine will be up to $695 per adult and $347 per child!

There are exemptions to the individual mandate, but for most folks, those who are eligible for affordable health insurance but don’t enroll or go without health insurance for more than 3 months (in a calendar year) may be subject to the fine. So staying compliant should be of interest to you if you don’t want your tax return eaten into or to be required to make a payment at tax time. So how does this work if you’ve lost your job after the open enrollment period for ACA health insurance?

First, let’s start with a few definitions/acronyms:
ACA – Affordable (health) Care Act
ESI – Employer sponsored insurance
MEC – Minimum essential coverage • (See what counts as MEC.)
SEP – Special enrollment period

1. Do I qualify? If you’ve lost your job involuntarily (eg. not quit) and that company was the source of your healthcare insurance, then yes. Know that your ESI must terminate before a subsidized ACA Marketplace plan’s coverage can begin. Anyone who is lawfully present in the US can enroll in a Marketplace plan, but not everyone can receive the tax credits. Even if you don’t receive tax credits, or if you have Medicare but you want a secondary plan, you can enroll in a Marketplace plan.
2. What happens if you lost your job before the ACA open enrollment period for this year begins–or after it has closed? Call the Marketplace at 800-318-2596. Explain that you’ve lost (or will lose because of your forthcoming layoff) your health insurance due to an involuntary loss of work, and ask for an SEP. That will give you 60 days to apply for a Marketplace plan. The 60 days begins the day of your qualifying life event (for example the date you lost your job.) Then go to healthcare.gov to choose a plan, having coverage begin the day after your ESI ends.
3. What is the deadline/timeframe? You’ll want to get on top of this quickly after your job loss in order to avoid going the aforementioned 3 months without health insurance. This will help you avoid the fine and also having to wait all the way until the next year’s open enrollment period. Now let’s say that you know the date of your last day of work at your job in advance, it is recommended that you go ahead and apply for a Marketplace plan. Time is also of the essence since, as mentioned above, your SEP begins the day of your qualifying life event—not necessarily the day you call to request your SEP.
4. Are there other ACA compliant options besides Obamacare or a costly independent policy? Yes. If you’re not already covered by your spouse’s health insurance, you could try to be added to that plan. Medicaid and Medicare, if you qualify. Christian Healthcare Ministries has a cost sharing plan that can help offset the cost of your healthcare. Here’s more information on how it works. Medi-Share is another similar option.

More information on this topic can be found here and at NHeLP, Kaiser Family Health, Center for Budget and Public Policy, Community Catalyst, Families USA, and Enroll America.

If you miss the December 15th deadline for ACA Marketplace enrollment, you still have a couple of options: Farm Bureau Health Plans and short-term coverage. Be aware the latter is less comprehensive than other types of insurance, and that both can potentially deny consumers with pre-existing conditions. (The Tennesseean p. 5D, 2 Dec. 2018)

My condolences on your job loss and best wishes on your choice of health coverage. For an Action Plan to help you get started on your job search, see this earlier article here at my blog. Thanks to Rachel Clifton at the Tennessee Justice Center for her help with the information in this article. Please comment if you have any additional helpful information to add. For a video presentation of this post, click the image below. And if this information has been helpful to you, please share it with your social network.

Don’t miss a thing. Subscribe to receive updates by email.
Looking for a new job? Want to get the one you want faster? Check out my new book,  Here Today, Hired Tomorrow.