The first open enrollment period for insurance under the Affordable Care Act ends March 31, and individuals who don’t have insurance by that deadline could face penalties.
Joining us to discuss enrollment, the deadline, and those penalties were three guests who are experts on what the Affordable Care Act provisions mean for Missourians:
- Sidney Watson, J.D., Professor, Saint Louis University Health Law Policy Center
- Nancy Kelley, Director of Engagement and Advocacy at Saint Louis Effort for AIDS
- Jeremy Milarsky, Navigator Program Manager at Primaris in Columbia, Mo.
Watson specializes in health law and Kelley and Milarsky’s organizations offer navigation services to help people sign up for insurance on the healthcare exchange.
The Deadline
With 19 days left to enroll, the federal government hopes to enroll an additional 2 million people for a total of 6 million enrolled – a goal that is possible to meet now that the healthcare.gov website is working, said Kelley, adding that the entire process can take less than an hour with a navigator.
Part of the reason why some people are hesitant to enroll is that they think the cost will be too high, Milarsky said. But when they see their options, they are often “pleasantly surprised.”
“We have thousands of Missourians that are eligible to buy plans that they normally would be completely priced out of,” he said.
For more on eligibility for tax subsidies, see the Kaiser Family Foundation subsidy calculator or visit the Federal Marketplace. More information can also be found on previous St. Louis on the Air shows from July 2013 and January 2014.
To find a navigator near you, visit the Cover Missouri website, which has a zip code search tool.
The Penalty
According to Watson, if you are eligible to sign up for health insurance but do not sign up by March 31, you will be penalized on next year’s income tax. The penalty will either be $95 per adult or one percent of the household income, whichever is higher.
“For most people, the tax penalty is a nudge,” she said. “People are going to start seeing it next year on their income tax returns and are going to have to make that decision for themselves whether they want to pay that money in taxes or whether they want to use those dollars to purchase the new health insurance that’s available through the Marketplace.”
For more detail on the penalty, see the healthcare.gov website, which states that the maximum penalty is the national average yearly premium for a bronze plan on the Marketplace. However, said Watson, most people at that income level have insurance provided by their employers.
“One of the things that gets lost in the tax penalty discussion is not only are you paying money for nothing, you’re just paying a penalty, but you are also left out of having health insurance,” Kelley said. “When you’re comparing costs, you’ve got that unknown of what are my health costs going to be without insurance”
“The reality is that health care costs are a major, if not the major, driver behind family bankruptcy. And so even though you think nothing is going to happen, sometimes it does. And so you would look back and think it might have been better to get that health plan,” Kelley added.
Separating Fact from Myth
In the course of answering questions from listeners, our guests mentioned several common myths about the Affordable Care Act and the heath care exchanges. Below is a list of those myths as well as the facts.
- The Obamacare Plan: The health insurance provided on the state and federal exchanges is private insurance, not government insurance. Thus, there is no “Obamacare plan.” In Missouri, the private insurers are Coventry and Anthem BlueCross BlueShield.
- The Medicaid Expansion Gap: If you live in a state that has not expanded Medicaid and fall into the gap between being covered by Medicaid and receiving a subsidy to sign up on the exchange, you will not be penalized for lack of insurance.
- Same Penalty for Everyone: The tax penalty, like the tax subsidy, is income based. See the penalty section for more information.
- If You Lose Your Insurance, You Have to Pay the Penalty: If you lose your insurance due to the loss of a job or a divorce then you will be eligible to sign up for insurance on the marketplace outside of the open enrollment period. You also have a three month grace period to find another job or sign up for insurance before the penalty begins to apply.
- Navigators Are Out To Steal Your Personal Information: “We do not keep your personal information,” Malarsky said. “We don’t even sell the policies…We’re just there to show you your options.”
Updated Thursday March 13 at 11:56 a.m. to correct an error in fact. An earlier version of this story incorrectly identified Medicaid as Medicare.
St. Louis on the Air provides discussion about issues and concerns facing the St. Louis area. The show is produced by Mary Edwards and Alex Heuer and hosted by veteran journalist Don Marsh.
