Who Needs To Enroll For Health Insurance This Year? | KERA News

Who Needs To Enroll For Health Insurance This Year?

Nov 17, 2014

It's week one of signups for health care on the federal marketplace. Should you enroll? What's the penalty for opting out? 

You Might Already Be Covered

The Affordable Care Act (ACA) requires most people to have some form of health insurance coverage, or pay a penalty. As The Texas Medical Association explains in the series "Hey Doc," If you have health coverage in one or more of these ways, there's no need to enroll: 

  • Government-sponsored insurance (such as Medicare, Medicaid, the Children’s Health Insurance Program, TRICARE, the veterans health program);
  • Employer-sponsored coverage;
  • Insurance bought on your own in or outside of the ACA marketplace that meets the new ACA requirements; or
  • A "grandfathered" health plan: a health plan in existence before the health reform law (March 23, 2010) that is exempt from some of the new ACA requirements. 

The Obama administration has also said that if your insurer renewed an old policy that doesn’t meet the new ACA requirements, that might still satisfy the mandate for 2015. Check with your insurance company.

Not Covered? Shop On The Marketplace 

You can preview and compare 2015 health insurance plans online, at healthcare.gov. And if you have questions, contact the Marketplace Call Center 24 hours a day, 7 days a week.

Penalties For Opting Out?

If you didn’t have insurance in 2014, and you didn’t qualify for one of the exemptions, you will have to pay a penalty when you file your taxes at the end of the year. The penalties increase each year.

  • For 2014, you will pay either $95 per adult and $47.50 per child, or 1 percent of your family income, whichever is greater.
  • In 2015, the fines begin at $325 per adult and $162.50 per child, or 2 percent of your family income, whichever is greater.
  • In 2016, the fines increase to as much as $695 per adult and $347 per child, or 2.5 percent of family income, whichever is greater.

You can find each week’s “Hey, Doc” Q&A and a lot more information at Texmed.org/Heydoc as well as in TMA’s patient blog at MeAndMyDoctor.com.