“Who’s Exempt from the ACA Individual Mandate to Have Health Insurance?”

During several recent meetings this question was posed a number of times by curious employees and a few their employers. It seems many folks are still unclear about the exemptions. Many also were unclear on the amount of the penalties.

Below is a summary on exemptions and individual penatlies published recently in a Kaiser Health News article addressing these FAQs:

Who’s Exempt from the Requirement to Have Insurance?

 The list of possible exemptions is a long one. You may be eligible for an exemption if:
• Your income is below the federal income tax filing threshold.
• The lowest priced available plan costs more than 8.05 percent of your income.
• Your income is less than 138 percent of the federal poverty level (about $16,105 for 2015 coverage for an individual) and your state did not expand Medicaid coverage to adults at this income level as permitted under the health law.
• You experienced one of several hardships, including eviction, bankruptcy or domestic violence.
• You are a member of an Indian tribe, health care sharing ministry or a religious group that objects to insurance.
• You are in jail.
• You are an immigrant who is not in the country legally.

Many also asked about the penalties. More from the KHN article:

Penalties: How Much?

For 2016, the penalty will be the greater of $695 or 2.5 percent of income.
Although much of the discussion is often about the flat dollar penalty – $325 in 2015 — many people will be paying substantially more than that. A single person earning more than $26,550 would not qualify for the $325 penalty ($26,550 – $10,300 = $16,250 x 2 percent = $325.) So the 2 percent penalty is the standard that will apply in most cases, say experts. For example, for a single person whose modified adjusted gross income is $35,000, the penalty would be $494 ($35,000 – $10,300 = $24,700 x 2 percent = $494. That same individual would have paid $249 in penalties for 2014.

The penalty is capped at the national average price for a bronze plan, which the IRS announced was $2,484 for an individual and $12,240 for a family of five or more in 2015.

To read about other ObamaCare FAQ’s go to FAQ: What Are The Penalties For Not Getting Insurance?

New Source of Over-Utilization? Study Indicates Use of Retail Clinics May Be Increasing Healthcare Costs

Use of retail clinics leads to higher costs.

Seems a bit counter-intuitive doesn’t it?

You’d think that the use of retail clinics like those found in some CVS and Kroger stores and typically staffed by nurse practitioners would be apt to lower total costs. In fact it’s based on this premise that some employers and carriers are encouraging employees to use these clinics by covering more of the cost of the visit.

HHS Publishes Out-of-Pocket Regs for 2017

This is hot off the presses. The most important announcement this past week is that HHS published the increased out-of-pocket regulations for 2017. Originally, the ACA was to cap deductibles at $2,000. That seems like a long time ago and was never really followed.

In the big picture, this increase seems to indicate that they see costs continuing to increase and consumers will need to consider mitigating those increases by moving to higher deductible plans.

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