I don't have health insurance

Obtaining Coverage

Under the Affordable Care Act, there are three ways for uninsured people without the option of employer-based coverage to get health insurance, based on income:

1) You can purchase insurance independently (through a licensed insurance broker or directly from a health insurance company).

2) You can buy a plan at the state's new health insurance marketplace called Covered California.

3) You may also be covered by an expansion of Medi-Cal, the state government's health insurance program for low-income individuals and families.

Eligibility of expanded Medi-Cal program: If your 2013 income is the same or less than the number that corresponds to your household size in the chart below, you are likely eligible for Medi-Cal. If your income is higher than the number you see below, you may buy insurance from a licensed insurance broker, directly from an insurance company, or through the Covered California marketplace.

 

Household Size

Income

1

$15,850

2

$21,400

3

$26,950

4

$32,500

5

$38,000

6

$43,600

7

$49,100

8

$54,700

 

Insurance coverage in the private market or through Covered California

You may continue to purchase health insurance through a licensed broker or directly from insurance companies.  Any licensed insurance company must offer plans that meet the federal minimum requirements.  Additional plans may be available that suit your particular needs. 

Covered California: Covered California offers four qualified health plans similar to those available on the private market today. These plans comply with the Affordable Care Act.

There will be four basic levels of coverage: platinum, gold, silver and bronze. Under federal law, every individual must be covered by a plan that meets the bronze level.  This ranking system will make it easier to compare plans in the same category or across categories. As the metal category increases in value, so does the percent of medical expenses that a health plan will cover. The health plans that cover more of your medical expenses usually have a higher monthly payment but you will pay less whenever you receive medical care.

You can choose the level of coverage that meets your health needs and budget:

Source: Covered California

 

The Individual Mandate

Starting January 1, 2014 most Californians will be required to have health insurance under the provisions of the “individual mandate.” If you or your family does not have coverage that meets federal requirements either through an employer or another source, you will be required to purchase health insurance that meets the federal requirements. If you do not have insurance by March 31, 2014, you will owe a tax penalty to the IRS.

IRS Tax Penalty: In the first year, that penalty is $95 per person or one percent of your adjusted gross income, whichever is greater. For example, an individual without insurance making $45,000 net a year* would pay a penalty of $352 for the 2014 tax year.  By 2016, that penalty would increase to $695 per person or 2.5 percent of income. That same uncovered individual making $45,000 would now owe $881 to the IRS. Under the law, penalties will increase each year going forward with penalties for uninsured children being half the adult amount.

  2014 2015 2016
  Annual penalty: $95 per adult + $47.50 per child, up to $285 or 1% of income, whichever is greater. Annual penalty: $325 per adult + $162.50 per child, up to $975 or 2% of income, whichever is greater. Annual penalty: $695 per adult + $347.50 per child, up to $2,085 or 2.5% of income, whichever is greater.
Number of adults in family
Number of chlidren in family
Adjusted Gross Income*
Your tax filing status
* Adjusted Gross Income is your income minus deductions. To calculate your Adjusted Gross Income click here

Calculation Results

  2014 2015 2016
Your projected maximum penalty

0

0

0

 DISCLAIMER: These results are approximate and should not be used in any official capacity when filing taxes.

Who is exempt from the mandate? Some people, however, are exempt from both the mandate and the penalty. Those exclusions include the following:

    • People who would have to pay more than 8 percent of their income for health insurance
    • People with incomes below the threshold required for filing taxes (in 2012, $9,750 for a single person and $27,100 for a married couple with two children)
    • People who qualify for religious exemptions
    • Undocumented immigrants
    • People who are incarcerated
    • Members of Native American tribes

Catastrophic Coverage

Catastrophic coverage is not designed for day-to-day medical expenses such as doctor visits, prescription medicines or even emergency room visits. It is designed to cover excessive medical bills that occur above the limit that you would be able to manage financially.

Covered California offers catastrophic coverage plans for those who have not yet turned 30, or low income individuals over 30 who can provide a certification that they are without affordable coverage or are experiencing hardship. For a 25-year-old non-smoker purchasing catastrophic coverage, the average monthly premium will be an estimated $184 per month (or $2,208 for the year). Those purchasing catastrophic coverage are also ineligible for tax subsidies to pay for these plans and will have to pay the full price of their premiums.

For individuals 30 years of age or older, the purchase of a catastrophic plan does not meet the minimum benchmark for coverage as set by the federal government. To comply with the individual mandate, minimum coverage starts at the  bronze standard.

 

Health insurance tax credits may be available

For those individuals and families purchasing insurance through Covered California, federal law limits the amount that you are allowed to pay out-of-pocket, based on your family income. Any additional costs are paid by taxpayers through subsidies (based on the federal poverty level):

 

 

Percent of Federal Poverty Level

Maximum Amount Premium Costs for Insurance

Up to 133 percent

2 percent of income

133-150 percent

3-4 percent of income

150-200 percent

4-6.3 percent of income

200-250 percent

6.3-8.05 percent of income

250-300 percent

8.05-9.5 percent of income

300-400 percent

9.5 percent of income

 

For further information on tax credits, visit Covered California to calculate the estimated monthly premium cost for your chosen insurance plan.

 

You may owe taxes for tax credits you receive: If you receive a subsidy and your income changes during the year to make you ineligible or reduces your eligibility, you may receive a tax bill to repay that subsidy.

 

Deducting unreimbursed medical expenses

The Affordable Care Act increased the tax burden for some individuals who have high medical expenses in any given year and who itemize their tax deductions.   The Affordable Care Act also  increased the amount of qualifying unreimbursed medical expenses eligible for a tax deduction from over 7.5 percent of adjusted gross income to over 10 percent of adjusted gross income as of January 1, 2013.  If you are 65 or over before the end of the year the deduction is claimed, the threshold remains at 7.5 percent of adjusted gross income through 2016.