Facts about the fee for not having health insurance in 2016

I believe all families deserve the peace of mind and financial security that comes with access to quality and affordable health care coverage.

David Sayen

David Sayen

No family should live in fear that an unexpected illness or accident could throw them into financial turmoil. All people deserve to know they can fill their prescriptions, take their children to the doctor, and get care to stay healthy when they need it.

The good news is that affordable coverage through HealthCare.gov is available. With financial assistance, 7 out of 10 people can find plans with premiums of less than $75 per month.

My priority is to make sure families are informed about the options available to them. That includes making sure people know that having health insurance is now the law. If you can afford health insurance but choose to not enroll for 2016, you may be required to pay a fee when you file your 2016 federal income taxes.

Your best option is to visit HealthCare.gov, learn about the tax credits you may be eligible for, and enroll in a health plan that meets your needs, rather than risk going without insurance and paying a fee.

Here are facts about the fee:

1. The fee is calculated one of two different ways, depending on your situation. The fee for not having health insurance if you can afford it is calculated either as a percentage of your annual household income or a set amount for each person in your household who doesn’t have coverage. When you file your federal income taxes, if you are uninsured for more than three months despite having access to affordable coverage, you’ll be required to pay whichever amount is higher. Resources on HealthCare.gov will help you estimate the fee you’ll have to pay if you forgo insurance.

2. The fee is increasing. For 2016, the fee you’ll have to pay if you choose to go without health insurance will rise to $695 per uninsured adult or 2.5 percent of your household income — whichever is higher. For many people, that’s more than the yearly cost of affordable plans they can find on HealthCare.gov. Generally, the higher your income, the higher the fee you will have to pay.

3. Every month without coverage counts. The fee is calculated based on the number of months you, your spouse, or your tax dependents went without qualifying coverage, such as an employer-sponsored health plan, Medicare, Medicaid or coverage through HealthCare.gov. The more months you go without coverage, the higher the fee you’ll have to pay, up to the maximum.

4. Exemptions from the fee are available for some. People with very low incomes and or who meet other specific conditions can receive an exemption from the requirement to have health insurance. Additional information about exemptions and a tool that helps you determine if you qualify for an exemption is available on HealthCare.gov.

5. The final deadline to sign up for 2016 coverage through HealthCare.gov is Jan. 31. A Special Enrollment Period around the April 15 tax filing deadline will not be offered this year. If you don’t enroll by then, you may have to wait another year to get coverage and may have to pay a fee when you file your 2016 income taxes.

If you have questions about the fee or how to sign up for coverage through HealthCare.gov, there are a number of ways to find free, personal help. Enrollment specialists are available 24 hours a day, every day at 1-800-318-2596. Free, confidential, in-person assistance is also available in communities across the nation.

Visit LocalHelp.HealthCare.gov to find help in your neighborhood.

Editor’s note: David Sayen is Medicare’s regional administrator for Arizona, California, Nevada, Hawaii, and the Pacific Territories.

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