The Numbers Don’t Lie: The AHCA Will Cost Us

The Congressional Budget Office has released its “score” of the American Health Care The AHCA Will CostAct (AHCA) and the bottom line is that the AHCA will cost the cancer community greatly.

The Congressional Budget Office (CBO) is a non-partisan agency that is tasked with analyzing proposed legislation to determine its financial impact.  Most recently the CBO analyzed the House passed bill designed to make major changes to the Affordable Care Act (ACA). The CBO concluded that while the bill would reduce the overall federal deficit by $199 billion over a 10 year period, it would do so at the cost of Americans.

The biggest savings would come from cutting Medicaid, a programs that provides coverage to individuals with low incomes and disabilities.  The second largest cost savings would come from reducing the financial assistance that is currently available to many people who purchase individual health insurance through the ACA Marketplaces.

As a result of these changes, the report estimates that by 2026, 23 million Americans would be without health insurance. The CBO also notes that the AHCA could mean some Americans would buy policies that don’t cover “major medical risks.” The CBO doesn’t consider those individuals to be insured due to the policies’ inadequate coverage.

According to the CBO, under the AHCA “it would become more difficult for less healthy people (including people with preexisting medical conditions) in [some] states to purchase insurance because their premiums would continue to increase rapidly.”  Additionally, the AHCA would result in higher premiums for older, less healthy Americans.

Although none of this information is unexpected, the CBO report confirms our beliefs that the AHCA would undoubtedly harm the cancer community.  But remember the AHCA is not law yet! The Senate has to pass a bill, the two versions have to be reconciled, and then the President has to sign it into law.  So there is still time to act!

Contact your Senators, go to town halls being hosted by your elected officials, and educate yourself on how this law could really impact you.

Stay tuned to this blog as we will provide updates as more information becomes available.  Also, please join us on June 21, 2017 for a free webinar – An Update to Our Health Care System.  It is open to all and we are providing free CEUs for health care professionals. Register today!

Today Congress Voted to Take a Step Backwards

Today, the U.S. House of Representatives voted, by a two-vote margin, to pass the A Step BackwardsAmerican Health Care Act.  As we have talked about in prior posts, if signed, this law is a step backwards and would hurt millions of Americans.

It has the potential to effect people with pre-existing conditions like cancer, individuals who get their health insurance through an employer, people with disabilities or low incomes who receive care through Medicaid, and seniors receiving Medicare.

This bill was hastily thrown together and was passed without a score from the Congressional Budget Office, which means that Members of Congress don’t even know how much it is going to cost us.

For now, nothing has changed. The ACA Marketplaces are still open for business, Medicaid expansion still exists in the states that have expanded, and we still have the consumer rights afforded to us by the ACA.

Although this bill may appear to give people more choice when it comes to purchasing health insurance, it is important to remember that more choice doesn’t always mean better choice or more affordable choice. Lower cost plans that don’t provide adequate coverage for things like cancer treatment and mental health, will end up costing consumers more in the end.

It will likely be weeks before the Senate will consider the bill so now is the time to act. Contact your Senators, go to town halls being hosted by your elected officials, and educate yourself on how this law could really impact you.

Stay tuned to this blog as we will provide updates as more information becomes available.  Also, please join us on June 21, 2017 for a free webinar – An Update to Our Health Care System.  It is open to all and we are providing free CEUs for health care professionals.  Register today!

Latest Update on Changes to Our Health Care System – Our Worst Fears Realized

Our Worst Fears RealizedOnce again we find ourselves in the position of having to share some frightening news when it comes to health care system.  Last week, an amendment (referred to as the MacArthur Amendment) was proposed to the American Health Care Act (AHCA), the legislation designed to ‘repeal and replace’ the Patient Protection and Affordable Care Act (ACA). In the last few days there have been additional negotiations to try to secure enough votes in the House of Representatives to pass this legislation.  According to new reports a vote is expected on this new version any day now. To state it plainly, the MacArthur Amendment is our worst fears realized.

The MacArthur Amendment makes a bad bill worse, and would:

  • Result in more than 24 million people losing their health insurance coverage;
  • Eliminate the Medicaid expansion program and cut more than $800 billion from Medicaid over the next decade;
  • Decrease the solvency of the Medicare Trust Fund by four years;
  • Eliminate the critical premium tax credits which lower the monthly premiums of plans being sold in the Marketplace for people;
  • Eliminate public health funding by repealing the Prevention and Public Health Fund established by the ACA;
  • And possibly most significantly, the new proposal would allow states to opt out of consumer protections, which would allow insurance companies to:
  • Not cover Essential Health Benefits – this means that insurance companies could decide to no longer cover chemotherapy, prescription drugs, prevention services, or hospitalization.
  • Increase costs for older adults – currently older adults can only be charged up to 3 times more for their coverage. This bill wants to increase that ratio to allow insurance companies to charge up to 5 times more for their coverage. Read this fact sheet for more information about how this bill would hurt older adults.
  • Charge people with pre-existing conditions higher premiums – while those states would then have to create a high risk pool, coverage in high risk pools could cost more, be delayed, or even have enrollment limits. High risk pools are not a new idea. In fact, more than 35 states had high risk pools to try to help people with pre-existing conditions access health insurance coverage, before the ACA became law. While those high risk pools offered a lifeline for many people to get access to coverage when they couldn’t get it another way, they were not a solution to the problem. For example, in California, the state’s high risk pool only offered coverage up to $75,000 a year. Cancer care is often much more expensive than that, which left people to pay for their care out-of-pocket. Many of those state high risk pools had 6-month waiting periods for coverage if you had a pre-existing condition, wait lists due to state budget constraints, and very high deductibles and out-of-pocket costs. Kaiser Health News has a video describing why high risk pools may sound like a good idea, but have some challenges in reality.

The Kaiser Family Foundation has an excellent side-by-side comparison of the ACA and the AHCA and the potential changes to our health care system.

It is important to note that the current bill specifically exempts these changes from impacting Members of Congress, so that their coverage is not reduced or their costs are not increased by this legislation.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  • Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To reach your U.S. Representative, you can call the US Capitol Switchboard at (202)-224-3121, and an operator will help to connect you. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people who need coverage actually get it for 2017. If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces if you qualify for a special enrollment period.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar.

If you aren’t sure what your health insurance options are or want to understand more about health insurance, visit CancerFinances.org.

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available.

Post-Election Update: How health insurance may be changing

how health insurance may be changingAs we have reported since the election, changes to our health care system are likely to occur in 2017 and beyond.  While we wait for further action by Congress, we will continue to provide you with information about some of the the possible changes to our health care system and how we get health insurance.

Here are 4 ideas that we have heard from Republican leadership: President-elect Donald Trump, Speaker of the House of Representatives Paul Ryan, and Senate Majority Leader Mitch McConnell:

  1. Provide Medicaid block grants to states
  2. Allow insurance companies to sell policies across state lines
  3. Provide tax credits for purchasing health insurance coverage
  4. Regulate drug prices

Let’s break down what these ideas may actually mean.

  1. Provide Medicaid block grants to states

Currently, Medicaid is funded through a matching system, with the federal government paying for part of the expense of providing Medicaid coverage and states picking up the rest of the cost. There currently isn’t a limit on the amount of funds a state can receive to meet the health care needs of its population.

A block grant is a fixed dollar amount to provide coverage for a state’s health care needs. When the money runs out, that’s it.  This greatly increases the chances that people would go without care.  For example, imagine a year where winter storms are particularly harsh and the flu season is extreme. This would increase the number of people in a particular state that need medical care. What would happen if the state has already spent its Medicaid funds by the end of November? Would no one receive medical care in December?

While the argument in favor of Medicaid block grants is to give states more flexibility to improve their Medicaid programs, in reality, a Medicaid block grant system would likely cause states to have to make tough decisions: a) reduce the number of people eligible for Medicaid; b) reduce the coverage available through Medicaid; or c) both.

Click here to learn more about why block grants only sound like a good idea.

There would also be an impact on hospitals and health care providers. In states that have expanded access to Medicaid, there are fewer uninsured people in those states.  When people are uninsured and need medical care, the burden is often placed on hospitals and health care providers to cover the cost of that “uncompensated care.” If uninsured individuals can’t pay their medical bills, then providers are the ones who suffer. Over the last few decades, many hospitals have had to close, because they can’t afford to cover that uncompensated care. The ACA reduced the amount of uncompensated care by increasing the number of people with health insurance coverage. A Medicaid block grant program would likely increase the number of people without health insurance coverage, increase uncompensated care, and place the burden back on health care providers.

And just to wade a little further into the weeds . . .

If individuals with more expensive pre-existing conditions don’t have access to Medicaid in their state, then they are more likely to enter the individual health insurance market.  Those individuals are most expensive to ensure, and insurers pass on those costs to everyone, which increases the cost of insurance for everyone. This has proven to be the case now. In states that expanded access to their Medicaid programs, the cost of premiums for individual plans in their state health insurance marketplace were, on average, 7% lower than in states that did not expand access to Medicaid.

  1. Allow insurance companies to sell policies across state lines

While there are some federal laws, like the Affordable Care Act (ACA), which provides consumers protections in health care, there are also state laws that provide protections. Those state laws can offer protections such as coverage mandates. For example, a state may require an insurance company to cover oral chemotherapy at the same rate as IV chemotherapy, to reduce the out-of-pocket expenses for patients. Some states even give their insurance commissioner the power to reject excessive monthly premiums charged by insurance companies.

The problem with selling health insurance policies across state lines, is that it provides a loophole that allows insurance companies to not comply with certain state law requirements and offer less comprehensive coverage. Watch this great video which explains why selling insurance across state lines may sound like a good idea, but really poses some practical challenges.

  1. Provide tax credits to help people purchase health insurance coverage

Speaker Ryan’s “A Better Way” proposal suggests offering an “advanceable, refundable tax credit for individuals and families.” Making the purchase of health insurance tax deductible would be very helpful for many people in the United States.  However, for those with lower income levels, it does not sufficiently help those individuals get the money to buy adequate health insurance coverage in the first place. In addition, given the possible repeal of the ACA, whether there will be individual health insurance policies to buy is still unclear.

  1. Regulating drug prices

The cost of prescription drugs has been skyrocketing for decades, partly due to the significant scientific advances that have been made. It was proposed during the election to lower the cost of drugs through regulation. Watch this video to learn more about why regulating drug prices sounds like a good idea, but may not work the way we hope. The devil really is in the details.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.

 

  1. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, you can get personalized information on our recently released resource: www.CancerFinances.org.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming days, weeks, and months.

Post-Election Update: Are HSAs a health care solution?

As we anxiously await further action by Congress, we want to continue to share with HSA Health Care Solutionyou some of the possible changes to our health care system.  Today we are talking about if high deductible health plans and Health Savings Accounts (HSA) are a health care solution.

High Deductible Health Plans

A high deductible health plan is a health insurance plan that has a very high deductible. A deductible is a fixed dollar amount that you have to pay before your health insurance coverage begins. You could have a $0 deductible or a $10,000 deductible, depending on the plan that you choose.  This applies to plans that you might get through your employer or a plan that you would get from an insurance company. Now, when we say “high” deductible that is going to mean something different to each of us. But generally, in 2017, a high deductible health plan can have a deductible of $1,330 or more. But some plans have deductibles as high as $7,000. This means that you have to pay your $7,000 deductible out-of-pocket first, before your health insurance coverage kicks in.

The ACA did guarantee access to some preventive care and immunizations without having to pay a deductible, but if the ACA is repealed that protection might also go away.

Having to pay $7,000 or more before your health insurance coverage starts is something that most people would find difficult. And that is what contributed to the problem of medical bankruptcy. Prior to the ACA, 62% of all bankruptcies in the US were based on medical debt. And 78% of those individuals that had to file bankruptcy because of their medical bills actually had health insurance. Their higher out-of-pocket costs forced them into filing bankruptcy. Higher out-of-pocket costs also cause people to go without medical care.

On the other hand, the benefit to a high deductible health plan is that the monthly premium is usually lower. This might be a useful plan option if you are healthy and don’t need ongoing medical care. But, if you have a serious medical condition like cancer, you will likely pay more out-of-pocket with this type of coverage.

Health Savings Accounts or HSA’s

One way to deal with the costs of this type of coverage is by also choosing a Health Savings Account or HSA. A health savings account is a personal savings account where you can save money to pay for your medical expenses, including your deductible. There are significant tax benefits of having this account, because you don’t pay taxes on the money that you put in your HSA (up to a certain amount each year). The downside is that you actually have to have money to put in the HSA to use to pay your deductible and other medical expenses. And the concern is that most people don’t have the ability to save that kind of money to pay for their medical expenses.

Click here for a detailed overview of how high deductible health plans work with health savings accounts, and whether or not this is a realistic solution for individuals and families with lower incomes.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  1. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, you can get personalized information on our recently released resource: www.CancerFinances.org.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming days, weeks, and months.

The Affordable Care Act: An Overview of the Consumer Protections

The cancer community has benefited tremendously from the Patient Protection and Affordable Care Act (ACA).  As we have talked about in the past, the ACA is a complex law effecting multiple aspects of health care in this country.  One of the most important things the law has done is create new protections for all of us as consumers of health care.  We thought that it was important to review and highlight some of those consumer protections that apply now, regardless of where someone gets their health insurance: though the ACA Marketplaces, from an employer, or directly from a health insurance company.

  • Insurance companies can’t cancel your policy if you get sick or make a mistake on your application. In the past, insurance companies would cancel someone’s policy once they got sick under the claiming that they weren’t honest in their original applications, even if it was a simple mistake or omission.  Needless to say, a cancer diagnosis was a prime reason to rescind someone’s policy.  Now, insurance companies can only cancel your policy if they can show you committed fraud or intentionally lied about something important.
  • No annual or lifetime dollar limits on essential health benefits. For a cancer patient this means your insurance will be there for your entire cancer journey – from diagnosis to survivorship – even if that journey takes years or costs thousands of dollars.
  • Access to certain preventative services for free – meaning that these services are covered at 100%, even before you reach your deductible and without any co-payments.  Covered services include genetic testing, mammography screening and colon polyp removal.
  • All major medical insurance is guaranteed issue, meaning you can’t be denied coverage for any reason. Insurance companies used to take into consideration someone’s health status to determine if they would sell them coverage and how much they would charge for that coverage. Cancer was often a deal breaker.  It either meant extremely expensive coverage or no coverage all.  Since January 1, 2014, insurance companies can’t deny you coverage and you are free to change plans yearly.  This means cancer patients are able to take time off work for treatment and recovery or to change jobs, without the fear that they will never get insurance again.
  • You can’t be charged more based on health status or gender.  In the past, a cancer diagnosis often meant a significant increase in your premium.  And if you had a diagnosis like ovarian cancer, you would have been hit doubly hard because you were a woman with cancer.  Now, insurance companies are only allowed to consider four things when they are determining how much they are going to charge you: if you are buying an individual or a family plan, your geographic location, your age, if you use tobacco.
  • You have the right to get an easy-to-understand summary about a health plan’s benefits and coverage, called a summary of benefits and coverage (SBC).  This is critical for consumers to understand exactly what it is they are buying!
  • Health Insurance Marketplaces allow shoppers to compare health insurance plans that offer minimum essential coverage and include all new benefits, rights and protections of the law. Minimum essential coverage includes:
  1. Ambulatory patient services (outpatient care)
  2. Emergency Services (trips to the emergency room)
  3. Hospitalization (treatment in the hospital for inpatient care)
  4. Maternity and newborn care
  5. Mental health services and addiction treatment
  6. Prescription drugs
  7. Rehabilitative services and devices
  8. Laboratory services
  9. Preventive services, wellness services, and chronic disease treatment
  10. Pediatric services
  • Financial assistance is available to individuals, families and small businesses through the state Health Insurance Marketplaces.  There are two types of financial assistance: a premium tax credit and a cost sharing subsidy.  Eligibility for this assistance is based on family size and income level.  When entering the world of cancer treatment, the costs are overwhelming, and frankly almost impossible to handle without insurance.
  • The 80/20 rule and rate review provision help to keep insurers honest and keep rates down.  This rule means that most insurance providers must spend 80% of every dollar they take in on paying for claims and/or improvement in services and can only spend 20% on marketing and overhead costs.
  • You have the right to appeal any health insurance company decision. Under ACA and some state laws, you not only have the right to appeal a decision internally with your insurance plan, but you also have the right to ask for an external review.  This means that an external, independent, specialist will review your appeal and the insurance plan no longer has final say over whether to pay a claim.

None of these consumer protections existed prior to the ACA.  While we at Triage Cancer are the first to acknowledge that there are still many ways to improve our health care system, we are disheartened to think that we may be sent back to the days where a cancer diagnosis or having another serious medical condition may force you into bankruptcy, homelessness, or even not being able to get medical care.  The President-elect and congressional leaders have made numerous statements about their desires to “repeal and replace” the ACA.  While there isn’t a consensus as to what that looks like yet, you can read more about the possibilities being discussed here.

It is sometimes hard to remember how far we have come, but we only want to look forward, at how we can continue to improve the lives of those touched by cancer, and the rest of our country.

And you can help us do that.

  • Even though the election is over, as citizens, we still have a say in how our government is run. It is time to organize, mobilize, and advocate for the cancer community. Call or email your elected officials and tell them what the ACA means to you. Tell your story! To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page.
  • Communicate with your elected officials about your health insurance concerns. You can find the Facebook and Twitter handles for the current members of Congress here.
  • Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations. Both organizations have pledged to work to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people who will be impacted by the ACA’s repeal. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-story or at http://www.canceradvocacy.org/blog/share-your-aca-story/.

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017. If you want your policy to begin on January 1, 2017, you need to have picked a plan by December 15, 2016.  For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, our recently released toolkit, Finances 101, may be useful.

Stay tuned to our Blog and sign up for our newsletter, will continue to provide updates as more information becomes available in the coming months.

Don’t Miss these Changes to the 2017 Health Insurance Marketplaces!

In March 2016, the U.S. Department of Health and Human Services released new rules for Triage Cancer Blog Health Insurance Marketplace Changesthe health insurance marketplaces. These marketplaces are available to people who want to purchase their own health insurance in any of the 38 states that use the online federal marketplace (www.HealthCare.gov) or to any of the 13 states and District of Columbia that host their own health insurance marketplaces.

In a recent article published by Kaiser Health News, they provide a summary of three specific changes that may affect consumers using the 2017 federal marketplace (www.HealthCare.gov):

  1. Increased consumer access to information about the size of an insurers’ network of doctors and hospital.

New rules require insurers to give consumers 30-days’ notice if a provider is being removed from the health insurance plan’s network. Insurers must also provide continued coverage for up to 90 days for patients in active treatments (e.g., chemotherapy, or for women in later stages of pregnancy) – unless the provider is being dropped for cause.

  1. Increased warning for “surprise” medical bills from out-of-network providers.

A patient’s ancillary care, such as radiology or anesthesiology, will count towards an insurance plan’s annual out-of-pocket maximum, if the insurer does not notify the patient (within 48 hours) that they may receive care and bills from out-of-network providers.

  1. More standardized out-of-pocket costs for consumers.

This new rule was designed to make comparison shopping between plan choices easier for consumers. Federal regulators have created six standard plans that they are asking insurance companies to voluntarily offer in 2017.  These plans include specific costs for copayments, prescription drugs, primary care, mental health, and substance abuse treatments. This standardized plan design has been implemented in several states, including California, Oregon, and DC; and allows consumers to plan for possible expenses.  But these plans have been opposed by insurance companies. Because of this opposition, consumers will likely see both standardized plans and the current varied policies available in the marketplaces. In addition to these plans, HHS has decided that the maximum amount that consumers can be charged for annual out-of-pocket costs is $7,150 for an individual and $14,300 for family coverage.

For more information about the Affordable Care Act and health insurance options, read our Quick Guide on the ACA and Health Insurance.  Or read past blogs on health insurance topics, here.

Resources:

Kaiser Health News

Kaiser Family Foundation

Triage Taxes: The fee for not having health insurance

If you can afford health insurance and have chosen not to buy it, you will pay a fee when you file your federal tax return for the year you chose not to have coverage.  Called an individual shared responsibility payment, the fee is sometimes called the dollar-941246_640“penalty,” “fine,” or “individual mandate.”

You will owe the fee for any month you, your spouse, or your tax dependents don’t have health insurance that qualifies as minimum essential coverage— unless you qualify for an exemption

Learn about health coverage exemptions.

The fee for not having coverage in 2015:

The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.

 2% of household income/ Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace

OR

$325 per adult, $162.50 per child under 18/Maximum: $975

The fee for not having coverage in 2016 is the higher of these:

2.5% of household income/Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace

OR

 $695 per adult, $347.50 per child under 18/Maximum: $2,085

Learn more about estimating and paying the fee.

Triage Taxes: How Health Coverage Affects Your Taxes

When you file your taxes for 2015, you’ll need to include certain information about your health coverage, depending on the type of coverage you had.

You had Marketplace coverage in 2015:

If you enrolled in a health plan through HealthCare.gov or your state’s Health Insurance taxes-806396_640Marketplace, watch your mail for an important tax document called Form 1095-A—it’ll help you when you file your 2015 federal taxes. You also can download and print a copy from your Marketplace account on www.HealthCare.gov. Wait until you download or receive your 1095-A before you file your income tax return.

Double-check your Form 1095-A for things like the start and end date of your coverage and the number of people in your household, to make sure the information is correct. If you think anything is incorrect, visit www.HealthCare.gov/taxes to find out how to get a corrected Form 1095-A. Use information on your Form 1095-A to reconcile the difference between the amount of financial help you received with the actual amount you should have received based on your 2015 earnings. If you don’t file a tax return and reconcile your financial help, you won’t be eligible to receive it in the future.

You had coverage for all of 2015 through an employer, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) or coverage from another qualifying source:

If you and everyone in your household had coverage for the entire year through your employer, Medicare, Medicaid, CHIP or other qualifying coverage from another source, you’ll check a box on your federal income tax form that says you had coverage for all of 2015. You might get a tax document called a Form 1095-B or Form 1095-C from your employer, your insurance company, or from the government program that provides your coverage, like Medicare or Medicaid. You don’t need to attach it to your tax return or wait to get it before you fill out your tax return, but keep it in a safe place with your other tax records.

You didn’t have health coverage in 2015:

If you didn’t have health coverage for all or part of 2015, you may qualify for a health coverage exemption. Visit www.HealthCare.gov/exemptions-tool to see if you’re eligible for an exemption because you couldn’t afford coverage or if you met certain other conditions. If you get an exemption, you won’t have to pay the fee for not having coverage.

If affordable health insurance options were available but you chose not to enroll in coverage for 2015, and if you didn’t qualify for an exemption, you may have to pay a fee when you file your 2015 federal income taxes. The fee for not having health coverage in 2015 is $325 per person or 2% of your annual household income, whichever is higher. The fee for not having coverage in 2016 will be even higher—you’ll have to pay $695 per person or 2.5% of your income, whichever is higher.

Help is available:

  • For more information about how your Marketplace coverage will affect your taxes, visit HealthCare.gov/taxes or call the Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325.
  • Many people who signed up for Marketplace coverage can get free help with filling out their taxes. This may include free access to tax software programs, or free in-person assistance. For more information, visit IRS.gov/freefile or www.IRS.gov/VITA.

If you have questions about your taxes, visit www.IRS.gov.

Only a few days left to buy health insurance!

Do you need health insurance coverage for 2016?Triage Cancer Only a few days left to buy health insurance for 2016

Good news is that you still have a few days (until December 15th) to pick a plan on your state’s health insurance marketplace and have your coverage start January 1st.

Want even more good news? According to HealthCare.gov 8 out of 10 people who enroll through the Affordable Care Act’s Health Insurance Marketplaces qualify for financial help to lower the cost of their monthly premiums.

If you’re not sure what to be thinking about when shopping for a plan, take some time to watch our webinar on picking a health insurance policy.

Ready to start your application? Visit HealthCare.gov and pick your state from the drop down menu.