Health Care Reform – Requirement to Get Health Coverage
Authored By: Northwest Justice Project
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- Do I have to have health insurance?
- What is "minimum essential coverage?"
- How do I know if I need to get health insurance?
- I am required to have health insurance. What happens if I do not have it?
- How can I apply for coverage?
- What if I need help applying or understanding my options?
- What if I need legal help?
If you do not have health insurance or your health insurance does not cover the care you need, you might have options under the Affordable Care Act, the federal health reform law. Our publication called Health Care Reform – General Information has more information.
It depends. As of January 1, 2014, the law requires most people to have "minimum essential coverage." In general, if you do not have minimum essential coverage, you may have to pay an IRS penalty.
It is health insurance that is required to cover different types of medical services and to pay for a certain minimum amount of your health care costs.
You already have minimum essential coverage if you have health insurance through one of the following plans:
coverage through your job
Washington Apple Health (Medicaid) or Apple Health for Kids (CHIP)
Medicare and Medicare Advantage Plans
Student health coverage
Refugee medical assistance
Health programs through the Veterans Administration
Peace Corps Volunteer programs
Qualified Health Plans (QHPs) purchased on Healthplanfinder or other individual or group coverage
Most health insurance of the above types is minimum essential coverage. You may NOT have minimum essential coverage if your only health insurance is through one of the following plans (or is limited to certain benefits):
Coverage for vision only
Coverage for dental only
Cash "insurance" benefits (such as L&I disability cash payments)
If you do not have minimum essential coverage, you will have an IRS tax penalty unless an exemption, such as those listed below, applies to you:
you do not have to file taxes because your income is below the tax-filing threshold
you do not have a lawful immigration status and do not qualify for Medicaid or a Qualified Health Plan
you are in jail or prison
you are a descendant or enrolled member of a federally-recognized Indian Tribe
monthly premiums for the lowest cost coverage available to you would cost more than 8% of your household income
you have certain religious objections
your income is less than 138% of the Federal Poverty Level AND you live in a state that did not offer Medicaid Expansion (this exemption does not apply to Washington residents)
a financial or other hardship keeps you from getting coverage (the Health Benefit Exchange will decide if your hardship exempts you from coverage)
your lapse in coverage lasted less than three months in a row (this exemption is available to you only once per calendar year)
If any of these apply to you, you must file for an exemption from coverage with the IRS. Learn more at www.healthcare.gov/exemptions.
Contact the Health Benefit Exchange, a state-approved organization that administers many of the health reform coverage options, or go online at www.wahealthplanfinder.org. They can tell you whether you need to get coverage. They can also help you apply for coverage or an exemption. You can call them at 1-855-923-4633 (1-855-WAFINDER) or email them at firstname.lastname@example.org.
At the end of each tax year, the IRS will check to see if you were required to have health insurance. If you were, but did not have it for all or part of the year, the IRS will add a debt to your tax return for that year. This process is called the "individual responsibility penalty." The debt will cost:
in 2015: the greater of 2% of the household income or $325 for each adult uninsured household member
in 2016: the greater of 2.5% of the household income or $695 for each adult uninsured household member
If you have a child who did not have coverage, the penalty amount is half the adult amount. There are caps on the total penalty amount a family can owe.
You can apply for coverage through Healthplanfinder online at www.wahealthplanfinder.org, by phone at 1-855-923-4633 (1-855-WAFINDER), or by using a paper application from Healthplanfinder or your local DSHS office. If you go online, make sure you go to the correct website (www.wahealthplanfinder.org). There are copycat scams at similar sites.
Call an In-Person Assister or an insurance broker. You can find a list of In-Person Assisters at WashingtonLawHelp.org, or go to www.wahealthplanfinder.org and click on the "customer support" link to search for a navigator or broker in your area.
Apply online with CLEAR*Online - https://nwjustice.org/get-legal-help
- Call CLEAR at 1-888-201-1014
CLEAR is Washington's toll-free, centralized intake, advice and referral service for low-income people seeking free legal assistance with civil legal problems.
Outside King County: Call 1-888-201-1014 weekdays from 9:15 a.m. until 12:15 p.m.
King County: Call 211 for information and referral to an appropriate legal services provider Monday through Friday from 8:00 am – 6:00 pm. You may also call (206) 461-3200, or the toll-free number, 1-877-211-WASH (9274). You can also get information on legal service providers in King County through 211's website at www.resourcehouse.com/win211/.
Persons 60 and Over: Persons 60 or over may call CLEAR*Sr at 1-888-387-7111, regardless of income.
Deaf, hard of hearing or speech impaired callers can call CLEAR or 211 using the relay service of their choice.
211 and CLEAR will conference in interpreters when needed at no cost to callers.
Free legal education publications, videos and self-help packets covering many legal issues are available at www.washingtonlawhelp.org.
This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice.
This information is current as of April 2016.
© 2016 Northwest Justice Project — 1-888-201-1014.
(Permission for copying and distribution granted to the Alliance for Equal Justice and to individuals for non-commercial use only.)