There are two options to obtain health coverage after open enrollment.
(1) You can enroll in Short-Term Coverage plans all year long which will hold you over until the next enrollment period. These plans DO NOT meet the minimum essential coverage requirements under the Affordable Care Act (ACA). They are plans designed to provide temporary health care insurance during unexpected coverage gaps.
(2) You can still get qualifying ACA coverage with a subsidy by qualifying with a Special Enrollment Period (SEP). You are eligible for an SEP if any of the following apply to you:
- You lost your employer health coverage
- You recently became married, divorced, widowed, separated, or had a baby, adopted a baby
- You have recently moved
- Got out of jail
- Lost other creditable coverage
During Tax season, everyone is required to submit a 1095 Form with their taxes; these forms help determine if you need to comply with the new shared responsibility payment – the ACA no-insurance penalty. There are three types of form-1095.
- 1095A: This form is directly from marketplace which can also be accessed and printed from your healthcare.gov account. If you need help accessing your 1095A, please contact us at 215-613-4999.
- 1095B: This form is from the insurer. If you purchased health coverage without a subsidy, the insurer will be issuing your 1095 Form.
- 1095C: This form is from your employer if you’re on an employer health plan.
In what circumstances is the shared responsibility penalty applicable and how much is the ACA penalty?
If you do submit a 1095 form with your taxes OR have a gap of 3+ months in a calendar year without healthcare, you can be assessed the shared responsibility penalty. For tax year 2016, the penalty for not having health coverage is either 2.5% of your household gross income for the tax year or $695 per uninsured individual in your household – whichever is greater. The law varies from year to year.
This law applies to ALL individuals, including children and 65+ adults. For adults over 65, you can call us to speak with a Medicare specialist: 215-613-4999.
You do not have to pay the penalty in the following circumstances:
- You’re uninsured for 1-2 months. You don’t have to pay the fee for any month.
- The lowest-priced coverage available to you – from any source – costs more than 8.05% of your household income. In this case, the coverage is considered unaffordable.
There are other qualifying circumstances but these are most common.
The amount of tax credit you are assessed is determined by the following factors:
- State you live in
- Number of people in your household / dependents
- Age of plan enrollees
- Total yearly household income
To check if you are eligible for tax credits, click the link below:
If you received a tax credit to lower your health insurance premium and your actual income at the end of the tax year is higher/lower than what you estimated during open enrollment, you can be subject to repercussions.
- If you have earned more than what you originally estimated, you will have to pay back all or some of your premium tax credit at the time you file your taxes to adjust the tax credit to your income.
- If you have earned less that what you originally estimated, the IRS will refund you the difference from what you paid and what you should have – relative to income.
You must pay your bill directly to the insurer. Followings are the insurers’ contact number;
BlueCross: 1-888-879-4891 (billing) , 1-888-879-4891 (Pay by phone)
Customer Service: 1-800-275-2583
Dental: 1-800-332-0366 (PPO) 1-866-3357-3304 (HMO)
HSA account: 1-800-275-2583
ibxpress.com Tec Support: 1-800-626-6076
Pay by phone: 1-888-879-4897
Precertification (Service requiring pre-approval): 1-800-275-2583
Prescription Drug benefits: 1-888-678-7012
Medical: 1-866-565-1236 (off-exchange) 1-855-586-6960 (on-exchange)
Mail-order drug: 1-866-612-3862