What Uninsured Need to Know
Don’t have health insurance? Health care reform affects you. Health care reform was created to help you get health insurance and protect you from serious health and financial problems. We’ll help you choose a plan that’s right for you.
Get health insurance – it’s the law
You must buy health insurance or pay a federal government fine:
- 2015: $325 or 2 percent of your income, whichever is greater
- 2016: $695 or 2.5 percent of your income, whichever is greater
- Beginning in 2017, the penalties will be increased by the cost-of-living adjustment.
Use this calculator to estimate your tax penalty fine.
Is anyone excluded from paying a fine?
There are a few exceptions to the penalty, including:
- Religious reasons
- Not present in the United States
- In prison
- Not able to pay for coverage that is more than 8 percent of the household income
- An income that is below 100 percent of the poverty level
- Having a hardship waiver
- Not covered for less than three months during the year
Learn more at healthcare.gov.
Easier to get coverage
You can’t be denied coverage even if you have a serious health condition.
Options for buying a health plan
You can buy health insurance directly from HMSA or on healthcare.gov, the federal health insurance marketplace, which offers HMSA health plans.
More affordable than you think
Depending on your income, you may qualify for financial help to pay for health insurance premiums and out-of-pocket costs by going through healthcare.gov. Or you could qualify for QUEST Integration, the state Medicaid program, which costs nothing.
How much does it cost?
The cost of your health plan depend on your age and rates may be adjusted based on tobacco use. Health plans for older people may cost more than plans for younger people.
What do I get with my health plan?
ACA plans offer these 10 essential health benefits:
- Prescription drugs
- Ambulance service
- Emergency care
- Laboratory services
- Maternity and newborn care
- Mental health and substance use services
- Pediatric oral and vision services
- Rehabilitation and habilitative services
- Services for preventive care, wellness, and chronic disease management
Why do I need health insurance?
Health coverage could save you money in the long run. Without health insurance, you and your family’s health and finances are at risk from high medical costs. Accidents, surgeries, treatments, medications, and specialty care can easily cost you hundreds of thousands of dollars without insurance. And preventive care, such as screenings for cancers, diabetes, and heart disease, will protect your health.
I work part-time and don’t have coverage
If you work part time (less than 20 hours a week) and don’t have health insurance, you’ll need coverage or you’ll have to pay a fine to the Internal Revenue Service (IRS). Because of health care reform, you won’t be denied health insurance, even if you couldn’t get coverage in the past because of a serious health condition.
You can buy an HMSA individual plan directly from us or on healthcare.gov, the federal health insurance marketplace. Depending on your income, you may be eligible for financial help to pay for health insurance if you buy it on healthcare.gov.
This information is based on HMSA’s review of the Affordable Care Act (ACA). This overview is intended for educational purposes only and should not be used as tax, legal, or compliance advice.