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Health insurance is now a requirement for nearly all Americans. But not every American will find happiness with the same health insurance plan.
Below are answers to some of today's most common questions about shopping for health insurance.
The Patient Protection and Affordable Care Act, the law that requires most Americans to have health insurance, was enacted in 2010. But it was only in 2014 that you may have had to pay a penalty if you did not have health insurance. Since 2014, the penalties for not having health coverage have increased significantly.
The penalty for not having health insurance is calculated two different ways, as both a per person amount and as a percentage of your household income. You must pay whichever amount is higher. So, if you are without a health insurance plan in 2017, you'll face a tax penalty of 2.5 percent of your income, with a maximum amount equal to the total yearly premium for the national average price of a Bronze plan sold through the Marketplace.
The per person penalty amount is $695 per adult. For children under the age of 18, it is half that amount, $347.50, per child. The maximum due is $2,085. You are required to pay the fee when you file your federal tax return for the year you didn't have health insurance coverage. This is referred to as your "individual responsibility payment." Obtain an estimate of how much you'll owe, if uninsured, on the IRS website.
For those who skipped coverage in 2017, these penalties will be due at tax time in 2018.
Starting in 2016, companies with 50 or more employees were required to offer 95 percent of their full-time workers (those who work more than 30 hours a week) health insurance that is of minimum value and affordable.
Minimum value means that the plan pays at least 60 percent of covered services. Affordable means that the employees' share of the premiums costs them less than 9.5 percent of their annual salary.
When compared with plans you purchase on your own, job-based coverage is almost always the better deal because your employer is likely to pay some of your monthly premiums.
Health insurance obtained through your workplace will have its own open enrollment. Your employer should inform you about its open enrollment period.
If you don't have coverage through your work, you can buy coverage through the government-run marketplaces called exchanges. Some states run their own exchanges while others rely on the federal government. If your state doesn't have its own marketplace, you shop for health insurance through Healthcare.gov.
However, you're not required to buy your health insurance on the marketplace. You can buy an individual or family health insurance plan directly from an insurance broker or company. (To compare prices on various plans, fill out the form near the top of this page to get quotes from leading carriers.)
However, if you're eligible for government subsidies to help pay your monthly premiums and you wish to use them, you must buy through the government-run marketplace. You may be eligible for these subsidies or tax credits if your income is low to moderate and you do not qualify for Medicaid.
You can enroll in health insurance plans only during open enrollment periods. Open enrollment dates for 2018 begin Nov. 1, 2017 and end Dec. 15, 2017, for coverage to start on Jan. 1, 2018. The open enrollment period is shorten to only 45 days this year, down from 92 days the period has run the last two years. However, some states are extending the time that people have to buy health insurance. Currently, those states are:
If you buy after the Dec. 15 date in the states that are extending the enrollment period, you'll need to check to see when the coverage will start as most still require you to obtain your plan by Dec. 15 for it to start on Jan. 1, 2018.
If you miss out on open enrollment, you may qualify for a special exception (special enrollment period) and enroll in a health insurance plan at any time if you or someone in your immediate family:
There are five categories of marketplace insurance plans:
The categories have nothing to do with the quality or amount of care you receive. Instead, they determine how much you pay out of pocket for the services you use.
If you visit the doctor regularly and take prescription drugs, you probably want a gold or platinum plan because they pay 80 to 90 percent of the cost of services and you pay 10 to 20 percent out of pocket.
If you are healthy and don't take prescription drugs, you can pay less in premiums with a silver or bronze plan. However, if you become ill, you will pay a greater share of your medical bills.
If you're under 30 and in good health -- or you're able to claim a hardship exemption -- you may opt for a catastrophic plan that protects you in worst-case scenarios only, like accidents or serious illnesses.