Health Care Reform – Requirement to Get Health Coverage

Authored By: Northwest Justice Project LSC Funded
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If you do not have health insurance or your health insurance does not cover the care you need, you may have new options under the Affordable Care Act, the federal health reform law. Our publication called Health Care Reform – General Information has more information.

Do I have to have health insurance?

It depends. Starting 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 be subject to an IRS penalty.

What is "minimum essential coverage?"

Minimum essential coverage 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.
If you have health insurance through one of the following plans, you already have minimum essential coverage:

  • coverage through your job

  • Washington Apple Health (Medicaid)  or Apple Health for Kids, (CHIP)

  • Medicare and Medicare Advantage Plans

  • Government-sponsored coverage

  • 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. If your only health insurance is through one of the following plans (or it is limited to certain benefits), you may NOT have minimum essential coverage:

  • 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 one of the following exemptions 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 Line AND you lived in a state that did not offer Medicaid Expansion (this exemption does not apply to Washington residents)

  • you have a financial or other hardship that keeps you from obtaining coverage (the Health Benefit Exchange will determine 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 need to file for exemption from coverage with the IRS. You can learn more about this at www.healthcare.gov/exemptions.

How do I know if I need to get health insurance?

Contact the Health Benefit Exchange, a new state-approved organization that will administer many of the new health reform coverage options, or go online at www.wahealthplanfinder.org. They can tell you whether you need to get coverage. They can also either help you apply for coverage or apply for an exemption. You can contact them by phone at 1-855-923-4633 (1-855-WAFINDER) or email at customersuppport@wahbexchange.org.

What happens if I am required to have health insurance but I do not have it?

At the end of each tax year, the IRS will check to see if you were required to have health insurance. If you were required, but you 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 2014: the greater of 1% of the household income or $95 for each adult uninsured household member

  • 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.

How can I apply for coverage?

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, be sure to go the correct website (www.wahealthplanfinder.org). There are copycat scams at similar sites.

What if I need help applying or understanding my options?

If you need help applying for coverage, 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.

What if I need legal help?

CLEAR is Washington's toll-free 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 9:10 a.m. until 12:25 p.m. CLEAR works with a language line to provide callers with free interpreters as needed. If you are deaf or hard of hearing, call 1-888-201-1014 using your preferred TTY or Video relay service.

  • 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). 211 works with a language line to provide callers with free interpreters as needed. Deaf and hearing-impaired callers can call 1-800-833-6384 or 711 to get a free relay operator. They will then connect you with 211. 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.


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 2014.

© 2014 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.)