Tuesday, November 21, 2017
Health

Q&A: As deadline looms, more Obamacare extensions and exemptions

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This week's news that Americans can get extra time to enroll in a health insurance plan is the latest effort to ease the Affordable Care Act's difficult start.

The Obama administration had previously said March 31 was the final day to enroll in a 2014 plan and avoid a possible tax penalty for going uninsured. But now consumers can get more time if they try to apply through healthcare.gov and can't finish.

Tuesday's announcement is aimed at boosting enrollment numbers, particularly among younger, healthier people who could offset the higher costs of insurance for older, sicker Americans. But insurers worry the administration's other accommodations — including certain exemptions from having to buy coverage — could let too many healthy people opt out.

"The market reforms included in the (Affordable Care Act) are linked to the individual mandate," said Clare Krusing, spokeswoman for America's Health Insurance Plans. "So any broad exemptions to the mandate undermine the stability of the marketplace."

Others say the administration is seeking reasonable leeway for consumers. "I don't think they're overly generous," said Cheryl Parcham, private insurance program director for advocacy group Families USA, said of the exemptions. "They're fair."

As time grows shorter to get insured, here are some issues many are confronting:

How can I get more time to buy insurance?

You have to "attest" that you tried to get through the process before Monday and couldn't finish. Check the blue box on healthcare.gov to show you tried. Then, paper applications must be turned in before April 7 and online applications processed by April 15, for coverage beginning May 1. As always, you can get a special enrollment period in 2014 if you have a "qualifying life event," such as getting married, moving, losing a job or having a baby. The government has also added to that list "complex cases," such as consumers who were enrolled in the wrong plan.

Can I just bypass healthcare.gov and buy from an insurer after Monday?

No. Some insurers may be selling short-term policies but those won't meet the law's requirement to have a plan that meets minimum coverage requirements for at least 9 months of the year, said Carrie McLean, consumer insurance expert for eHealthInsurance. So you still may be subject to a tax penalty.

When is the next open enrollment period?

November is the start of open enrollment for coverage that takes effect Jan. 1, 2015.

I missed the deadline. How do I know if I'm exempt from a penalty for not having insurance?

Nine basic categories of exemptions range from poverty to being part of a special group, such as a federally recognized Indian tribe. Hardships will also exempt you, such as being homeless, a domestic violence victim, having a death in the family, or facing unpaid medical expenses.

What else qualifies as a hardship?

Your old plan was canceled and you "consider the other plans available unaffordable." And there is this catch-all: "You experienced another hardship in obtaining health insurance."

What could that include?

Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service, said you might use that one if, say, you spent the year coping with a severely flooded house. But the vague wording leaves open many possibilities.

How much could I owe for not having insurance?

If you aren't exempt, it's 1 percent of adjusted household income or a flat $95 per adult and $47.50 per child, up to $285 per family — whichever is higher. Most will pay the 1 percent, Haile said. On an adjusted income of $50,000, that's a $500 fine. And it goes up next year.

All that, and you still have no help paying medical bills. "You're throwing 1 percent of your income down a rabbit hole," Haile said. "You pay for the privilege of being uninsured."

How do I get an exemption?

Fill out the form on healthcare.gov. You may need to provide documentation such as copies of medical bills or insurance cancellation notices. You don't need to fill one out if your income is below the tax filing threshold.

Who decides if I qualify?

Federal officials who oversee the marketplace will determine if you are a hardship case. The Internal Revenue Service grants some of the other exemptions.

How easy will it be to get one of these exemptions?

No one can say. For instance, insurers that canceled certain plans were allowed to renew them for up to two years, yet many are choosing not to, said McLean, the eHealth manager. Consumers that had such plans could try to seek a hardship exemption, but their chances may not be good. Insurers argue those plans aren't "canceled" since they're offering to move customers into new plans, she said. Further, how will federal officials determine the new plans are unaffordable? "It's messy," McLean said.

When are exemption applications due?

It's unclear. Haile's advice: If you think you may qualify for an exemption, apply now.

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