The Enid News and Eagle, Enid, OK

Local news

October 6, 2013

Penalty for no health insurance begins in 2014

ENID, Okla. — People who choose not to participate in an insurance plan and do not participate in the Affordable Care Act must pay a fee known as the individual shared responsibility payment.

The penalty for not having health insurance starting in 2014 is 1 percent of yearly income or $95 per person for the year, whichever is higher. The fee increases every year, and in 2016 is 2.5 percent of income or $695 per person, whichever is higher. In 2014, the fee for children is $47.50 per child. The most a family would have to pay in 2014 is $285. Payments are made when a person pays taxes.

Under certain circumstances, people won’t have to make individual responsibility payments. Those reasons are:

• A person is uninsured for less than three months.

• The lowest-priced coverage available would cost more than 8 percent of household income.

• A person does not have to file a tax return because income is too low.

• A person is a member of a federally recognized tribe or eligible for services through an Indian Services provider.

• A person is a member of a recognized health care sharing ministry.

• A person is a member of a recognized religious sect with religious objections to insurance, including Social Security or Medicare.

• A person is incarcerated and not awaiting disposition of charges against him.

• A person is not lawfully present in the U.S.

There also are a number of hardship exemptions, including:

• A person is homeless.

• A person has been evicted within the past six months or facing eviction or foreclosure.

• A person has received a shutoff notice from a utility company.

• A person recently has experienced domestic violence.

• A person recently has experienced the death of a close family member.

• A person has experienced a fire, food or other natural or human-caused disaster that cause substantial damage to personal property.

• A person has filed for bankruptcy in the last six months.

• A person had medical expenses they could not pay within the last 24 months.

• A person experienced unexpected increases in necessary expenses due to caring for an ill, disabled or aging family member.

• A person expects to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required to give medical support to the child. In this case, they do not have to pay the penalty of the child.

• As a result of an eligibility appeals decision, a person is eligible for enrollment in a qualified health plan through the marketplace, lower costs on monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in qualified health plan through the marketplace.

• A person who was determined ineligible for Medicaid because their state didn’t expand eligibility for Medicaid under the Affordable Care Act.

Exemptions can be claimed when filling out a 2014 federal tax return, which is due April 2015, or a person can apply for exemptions in the insurance marketplace.

An exemption also may be received because coverage is unaffordable based on expected income.

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