Avoiding the Tax Penalty
If someone who can afford health insurance doesn’t have coverage, they may have to pay a tax penalty. The tax penalty is sometimes called the “individual mandate” or the “shared responsibility fee.”
Tax Penalty Amounts
In 2015, the fee will be 2 percent of consumers’ income or $325 per person; whichever is larger. In 2016, the fee will be 2.5 percent of consumers’ income or $695 per person; whichever is larger.
Minimum Essential Coverage
“Minimum essential coverage” is the type of health care coverage an individual needs to have or to get to meet the individual mandate/responsibility requirement under the Affordable Care Act and, therefore, avoid paying a tax penalty. This includes individual market policies, employment-based coverage, Medicare, Medicaid (full-scope Medi-Cal in California), CHIP, TRICARE, Veteran’s Coverage, and certain other coverage designated as minimum essential coverage by the U.S. Department of Health and Human Services. Covered California health plans are considered minimum essential coverage.
Minimum essential coverage does not include coverage providing only limited benefits, such as coverage only for vision care or dental care, and Medi-Cal covering only certain benefits, such as pregnancy-only coverage.
All Covered California health insurance plans, whether they are the catastrophic/minimum coverage, bronze, silver, gold or platinum, are considered minimum essential coverage.
Options for Consumers Who Are Not Eligible for Premium Assistance and Cannot Afford the Full Price of a Health Plan
If the full prices of plans through Covered California are too expensive, consumers have many different options to purchase health coverage that gives them both the quality and affordability they need.
Minimum coverage plan: If consumers are under age 30, or the lowest-cost Bronze plan offered through Covered California is more than 8 percent of their household income, they may be eligible for a minimum coverage plan (a.k.a. “catastrophic plan”). These “catastrophic” plans usually have lower premiums and mostly protect consumers from worst-case scenarios. Catastrophic plans through Covered California cover three doctor visits or urgent care visits, including outpatient mental health/substance use visits, with no out-of-pocket costs, and free preventive benefits. All other services will be full price but at the negotiated in-network price, until consumers spend $6,350, after which all in-network services are covered at 100 percent.
Medi-Cal: If consumers are between the ages of 19 and 64 and their income is at or below 138 percent of poverty ($15,856 for an individual), they may be eligible for free or low-cost Medi-Cal. They may also be eligible for Medi-Cal for another reason, such as being blind, disabled, or aged, depending on their assets. Consumers can apply for Medi-Cal through Covered California.
Proof of Health Care Coverage
When consumers file their 2014 tax return (most people will do this by April 15, 2015), they will have to enter information about their coverage (or their exemption) on their tax return. Consumers should then get a notice from their insurance provider by Jan. 31, 2015, describing their coverage for the previous year.
Paying the Tax Penalty
If consumers do not maintain minimum essential coverage during a particular year and they do not qualify for an exemption, they will need to pay a “shared responsibility payment” to the IRS on their tax return for that year.
Call us today to get your appointment to RENEW your insurance plan. If you came to us before or you signed up online or through the telephone. One of our Certified Covered California Insurance agents can help you !
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