Uninsured? Wondering if you have to buy health insurance because of the Affordable Care Act? Here's what the law requires, how to comply, how to get Obamacare if you want it, and what your alternatives are.
Do I Have to Get Health Insurance?
If you're uninsured and you don’t have a health insurance exemption, you’ll have to get health insurance. The Affordable Care Act’s individual mandate requires everyone who’s not exempt to get health coverage by January 1, 2014.
If you have health insurance through your job or a government program like Medicare, Medicaid or Tricare, that insurance satisfies the law’s requirement. You don't need to do anything else.
If you have an individual health plan, your insurer can tell you if your current policy meets the law’s requirements. If you’re uninsured, you'll have to get health insurance or face a penalty.
Is There a Way Out of Buying Health Insurance?
If you’re uninsured and not interested in getting insurance, getting a health insurance exemption will help you avoid a tax penalty. To find out if you qualify for an exemption and how to get an exemption certificate, read “Can I Get a Health Insurance Exemption?”
What Will Happen if I Don’t Get Health Insurance?
If you’re not exempt and you choose not to get health insurance, you’ll owe a tax penalty called the shared responsibility payment. This penalty increases over time, and the amount depends on your income.
The health insurance penalty rules can be complicated. For example, part of your income isn’t included when figuring the penalty amount. There’s an upper limit to the penalty you’ll have to pay if you’re wealthy; there’s a minimum amount you’ll have to pay even if you're poor.
If you’re weighing the cost of buying health insurance against the cost of paying the health insurance penalty, don’t forget to figure related costs into the mix. Costs that go along with the choice to remain uninsured include the cost of paying out-of-pocket for all of your health care expenses, not just the cost of the tax penalty. Also, a government health insurance subsidy, if you’re eligible, could lower the cost of buying health insurance.
Can I Get Help Paying for Health Insurance?
You could be eligible for a subsidy to make health insurance more affordable. The Affordable Care Act created two types of health insurance subsidies; both are income based.
The premium tax credit subsidy pays part of your monthly health plan premiums so buying health insurance is less expensive. It’s like getting a discount on the cost of health insurance.
The cost-sharing subsidy lowers your deductible, copays and coinsurance when you use your health insurance. Your health plan pays more of your medical expenses, and you pay less. It’s like getting a free upgrade on health insurance.
Lastly, if your income is low, you might be eligible for Medicaid. Most Medicaid programs don’t charge any monthly premiums for coverage, or charge a very small amount.
Learn more about how the subsidies work and whether you’re eligible for a subsidy to enroll in Obamacare by reading “Can I Get Help Paying for Health Insurance?”
How Do I Buy Health Insurance?
Although you can buy health insurance directly from a health insurance company, if you suspect you’re eligible for a subsidy or Medicaid, buy your health insurance through your state’s health insurance exchange, otherwise known as a marketplace, instead.
Your state’s health insurance exchange is the only place you can apply for a government health insurance subsidy; furthermore, that subsidy can only be used for health insurance you buy through the exchange. The exchange can also tell if you’re eligible for Medicaid and help you apply for it.
Even if you’re not eligible for Medicaid or a subsidy, you state’s health insurance exchange makes it easy to compare health plans. Since the plans offered through the exchange are in direct competition with each other, they may have lower monthly premiums than similar health plans sold elsewhere.
Find out how to contact your state’s health insurance exchange.
How Do I Pick the Best Plan?
To pick a health plan that best fits your needs, you first need some basic information about what's available.
All of the health plans sold on health insurance exchanges provide the same essential health benefits. Some plans may provide benefits above and beyond the essential health benefits.
All of the plans are categorized into one of four standard tiers. These tiers tell you the plan’s value. You can learn more about how the tiers work and which one might be the best fit for you in “Bronze, Silver, Gold & Platinum—Understanding the Metal-Tier System.” An additional health plan option, catastrophic health insurance, is available to people less than 30 years old, or people with a hardship exemption.
Your exchange have several different types of health insurance offered at each value level. For example, if you want a silver-tier health plan, you might have to choose between a silver HMO, a silver PPO, and a silver POS plan. If you aren't sure how different types of health insurance work, read “HMO, PPO, EPO & POS—What’s the Difference & Which Is Best?”