Affordable Care Act signup time running out
By Lailani Upham
Montana Insurance Commissioner Monica J. Lindeen greets the people at the Blackfeet Eagle Shields Elderly Center in Browning last week. (Lailani Upham photo)
BROWNING — March 31 is the last day to buy health insurance without a penalty.
Montana Insurance Commissioner Monica J. Lindeen is urging Montanans to get their insurance in before the deadline.
Folks without healthcare in 2014 may have to pay a fee and all their healthcare costs accrued, and will not be protected from very high medical bills, which can lead to bankruptcy.
“If you haven’t bought health insurance for 2014 and you want it, you need to act fast,” Lindeen said. “The last day to buy insurance in the individual market is next Monday. Barring some major change in your life, you will not be able to buy insurance beyond March 31.”
Lindeen; I.H.S. Director, Anna Whiting-Sorrell; and Lesa Evers, tribal relations manager for the Montana Department of Public Health and Human Services, have been touring Montana’s tribal communities aiming their presentations at ensuring all Montanans understand Obamacare well enough to make informed health insurance decisions for themselves and their families.
Last week the diligent team made two stops on Thursday; first stop at the Blackfeet elderly assistant-living housing Eagle Shield Center, and in the evening at Salish Kootenai College theatre.
The Obamacare legislation contains certain provisions unique to members of federally recognized tribes and those with access to Indian Health Service providers.
The town hall meeting, called “Obamacare in Indian Country: What You Need to Know” was free and open to the public.
At the tour events, navigators and certified counselors were on hand to help folks enroll in insurance.
The tribal events are part of Lindeen’s overall outreach to Montanans about Obamacare. Over 60 events in 30 Montana communities have been marked off with Lindeen and her staff since the healthcare.gov website rolled out last year.
“Montanans want real information, not spin,” Lindeen said. “I don’t have a dog in the Obamacare fight. I just want Montanans to know how it works so they can make the best choice possible for themselves, their families or their small business.”
The Affordable Care Act, most commonly called Obamacare – created a new, national open enrollment period for health insurance sold in the individual market. The market is the insurance term for policies purchased directly from agents, insurance companies or through healthcare.gov. The open enrollment period started on Oct. 1, 2013 and ends March 31. It applies to insurance policies sold in the healthcare.gov website – and all other policies sold in the individual market.
According to healthcare.gov, the health care law now requires all people who can afford healthcare to take responsibility for their own health insurance by getting coverage, or pay a fee.
The next open enrollment period does not begin until Nov. 15, 2014 – but policies sold at that time will be for 2015. The last time to buy insurance for this year is now, says the team.
However, open enrollment does not apply to insurance acquired through work or government programs like Medicaid and Healthy Montana Kids. It also does not apply to health care services acquired from the Veteran’s Administration or Indian Health Services health systems.
Lindeen’s team wants folks to understand there are certain exceptions to open enrollment. A “qualifying life event” can trigger a special open enrollment period, such as, marriage or the birth or the adoption of a child. Keep in mind though, a medical emergency is not a qualifying life event.
In a January article in the Charkoosta News, the two types of tax penalty exemptions available to American Indians and Alaska Natives were laid out:
• Tribal member exemption – A member of a federally recognized tribe and member of an Alaska Native village or regional corporation as defined in the Alaska Natives Claims Settlement Act (ANCSA)
- It is a statutory exemption
- Exemption can be applied for through the Health Insurance Marketplace or through the IRS filing process
• Indian Health Care Provider exemption – Those American Indians eligible for services from Indian Health Care providers such as Indian Health Service, Tribal Health Departments or Urban Indian Health Centers
- They include first and second generation descendants
- It is also known as a hardship exemption
- Exemption can be applied for through healthcare.gov, CSKT tribal health clinics, and the CSKT personnel office.
There is no deadline for exemption but encouraging people to apply for them as soon as possible or they will be paying a penalty at tax time next year, or waiting to an exemption, say CSKT Tribal officials.
For information and assistance related to the ACA:
• In the St. Ignatius area people can contact ACA certified application counselors: Char Neal at 745-3525, ext. 5001; Linda Ebner at 745-3525, ext. 5005; and Alice Moran at 745-3525, ext. 5087.
• In the Polson area the ACA certified application counselors are: Gloria Quiver at 883-5541, ext. 7319; or Rhonda Lozeau at 883-5541, ext. 7347.
• For information about Deferred Services, contact Teri Burke at 745-3525, ext. 5044.
Anna Whiting Sorrell, Billings Area Indian Health Service Director told the group, “I know together with tribes and the State we have a chance to make a difference.” Whiting Sorrell says by knowing and understanding what’s out there in terms of healthcare it can help I.H.S do better for the people. (Lailani Upham photo)
Article taken from the healthcare.gov website:
How do I qualify for an exemption from the fee for not having health coverage?
Most people must have health coverage or pay a fee (the “individual shared responsibility payment”). You can get an exemption in certain cases.
The individual shared responsibility payment
If you can afford health insurance but choose not to buy it, you must pay a fee known as the individual shared responsibility payment.
The fee in 2014 is one percent of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it’s 2.5 percent of income or $695 per person, whichever is higher.
If you’re paying under the $95 per person method, in 2014 the payment for uninsured children is $47.50 per child. The most a family would have to pay under this method in 2014 is $285.
You make the payment when you file your 2014 taxes, which are due in April 2015.
Exemptions from the payment
Under certain circumstances, you won’t have to make the individual responsibility payment. This is called an “exemption.”
You may qualify for an exemption if:
• You’re uninsured for less than 3 months of the year
• The lowest-priced coverage available to you would cost more than 8 percent of your household income• You don’t have to file a tax return because your income is too low (Learn about the filing limit.)
• You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
• You’re a member of a recognized health care sharing ministry
• You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
• You’re incarcerated, and not awaiting the disposition of charges against you
• You’re not lawfully present in the U.S.
If you have any of the circumstances below that affect your ability to purchase health insurance coverage, you may qualify for a “hardship” exemption:
1. You were homeless.
2. You were evicted in the past 6 months or were facing eviction or foreclosure.
3. You received a shut-off notice from a utility company.
4. You recently experienced domestic violence.
5. You recently experienced the death of a close family member.
6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
7. You filed for bankruptcy in the last 6 months.
8. You had medical expenses you couldn’t pay in the last 24 months.
9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
11. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.
12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
13. Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.
14. You experienced another hardship in obtaining health insurance.
How to apply for an exemption
If you are applying for an exemption based on: coverage being unaffordable; membership in a health care sharing ministry; membership in a federally-recognized tribe; or being incarcerated:
You have two options:
• You can claim these exemptions when you fill out your 2014 federal tax return, which is due in April 2015
• You can apply for the exemptions using the appropriate form:
o Form to apply for exemption based on coverage being unaffordable (if you live in a state using Healthcare.gov)
o Form to apply for exemption based on coverage being unaffordable (if you live in a state using its own health exchange)
o Form to apply for exemption based on membership in a health care sharing ministry
o Form to apply for exemption for American Indians and Alaska Natives and others who are eligible for services from an Indian health care provider
o Form to apply for exemption based on being incarcerated
Note: If you get an exemption because coverage is unaffordable based on your expected income, you may also qualify to buy catastrophic coverage through the Marketplace. This may be more affordable than your other options.
If you’re applying for an exemption based on: membership in a recognized religious sect whose members object to insurance; eligibility for services through an Indian health care provider; or one of the hardships described above:
• You fill out an exemption application using the appropriate form:
o Form to apply for exemption based on membership in a recognized religious sect whose members object to insurance
o Form to apply for exemption based eligibility for services through an Indian health care provider
o Form to apply for exemption based on a hardship
If your income will be low enough that you will not be required to file taxes:
• You don’t need to apply for an exemption. This is true even if you file a return in order to get a refund of money withheld from your paycheck. You won’t have to make the shared responsibility payment.
If you have a gap in coverage of less than 3 months, or you are not lawfully present in the U.S.:
• You don’t need to apply for an exemption. This will be handled when you file your taxes.