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Requirement to Get Health Coverage

Authored By: Northwest Justice Project LSC Funded
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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 will have an IRS penalty. Publication #5709EN

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Intro

If you do not have health insurance OR your insurance does not cover the care you need, you might have options under the Affordable Care Act. Health Care Reform – General Info has more details.

Do I have to have health insurance?

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 be subject to an IRS penalty.

What is "minimum essential coverage?"

It is the health insurance required to cover different types of medical services and pay for a certain minimum amount of your health care costs.

If you have health insurance through one of these 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.

  • TRICARE.

  • Peace Corps Volunteer programs.

  • Qualified Health Plans (QHPs) purchased on Healthplanfinder or other individual or group coverage.

If your only health insurance is through one of the following (or 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).

What happens if I do not have minimum essential coverage?

You will have an IRS tax penalty unless an exemption, applies to you, such as: 

  • 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/prison.

  • You are an enrolled member of a federally recognized Indian Tribe or are eligible for Indian health care services.

  • 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 lived in a state that did not offer Medicaid Expansion. (This does not apply to Washington residents.)

  • A financial/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. See www.healthcare.gov/exemptions.

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

Contact the Health Benefit Exchange, a state-approved organization that will administer many of the health reform coverage options, or go online at www.wahealthplanfinder.org. They can

  • Tell you if you must get coverage.

  • Help you apply for coverage or an exemption.

How do I contact the Health Benefit Exchange?

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

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 part/all of the year, the IRS will add a debt to your tax return for that year. They call this process the "individual responsibility penalty." In 2017, the debt will cost the greater of 2.5% of your household income or $695 for each adult uninsured household member. (NOTE: they could adjust the $695 fee for inflation for 2017.)

If your child 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?

  • Through Healthplanfinder online at www.wahealthplanfinder.org.

  • By phone at 1-855-923-4633 (1-855-WAFINDER).

  • By using a paper application from Healthplanfinder or your local DSHS office.

If you go online, make sure you go to the right website (www.wahealthplanfinder.org). Similar sites are often copycat scams.

What if I need help applying or understanding my choices?

Call an In-Person Assister (Navigator) or insurance broker. To find one, go to www.wahealthplanfinder.org. Click on the link in the upper right corner to search for one in your area.

 

5709EN

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 June 2017.

© 2017 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.)

Last Review and Update: Jul 17, 2017
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