You Do Not Have Insurance: How the ACA Helps People Without Insurance

Do I Have to Have Insurance?

Beginning in 2014, most people are required to have health insurance. This is called the “insurance mandate” or the “individual mandate.” People who do not have health insurance must pay a tax.

The Tax for Not Having Insurance

2014
  • $95 per adult and $47.50 per child (up to $285 for a family)
    OR
  • 1.0% of the family income (whichever is greater)
2015
  • $325 per adult and $162.50 per child (up to $975 for a family)
    OR
  • 2.0% of the family income (whichever is greater)
2016
  • $695 per adult and $347.50 per child (up to $2,085 for a family)
    OR
  • 2.5% of the family income (whichever is greater)
After 2016
  • The taxes will be increased every year based on the cost of living.

You will not be required to pay a tax if:

How Can I Get Insurance?

You can use the Health Insurance Marketplace to buy health insurance. The Health Insurance Marketplace is also known as the Health Insurance Exchange (or HIE). The Marketplace is like Travelocity or Orbitz, except you can buy health insurance rather than book travel and hotels.

The Marketplace gives you a menu of different insurance plans. You can compare the different plans, side-by-side, to see what they cover and how much they cost. Everything is laid out for you so that you can figure out which insurance is best for you and your family. Insurance plans will vary, but each plan must cover the same essential health benefits.

Each state has its own Marketplace. To find the Marketplace in your state, go to: https://www.healthcare.gov/get-coverage/

To find out more about the Marketplace, click here.

Do I have to buy my insurance through the Marketplace?

You do not have to buy your health insurance through the Marketplace. You can still get your insurance through your job, or buy your insurance through an insurance agent.

Can I Get Medicaid?

Medicaid is a health insurance program for certain people with low incomes. These people are:

Before the ACA, states had different rules about who qualified for Medicaid. It depended on if you had children, if you had a disability, if you were male or female, your age, and how much money you made. The ACA makes it easier to qualify for Medicaid. This is called Medicaid expansion.

However, only some states are expanding their Medicaid programs. If your state expands its Medicaid program, you may qualify for Medicaid. To read more about Medicaid Expansion, click here.

Even if your state did not expand Medicaid, you may still qualify for Medicaid depending on your income. You can apply for Medicaid to see if you qualify by choosing your state from the drop down menu here.

How Can I Pay for Insurance?

If you have moderate to low income, the Health Insurance Marketplace could help you pay for your insurance. When you use the Marketplace, it will tell you if you qualify for help. For more information about the Marketplace, click here.

What if I Have Health Problems?

Beginning in 2014, a health plan cannot deny benefits, limit benefits, or deny coverage to anyone with a “pre-existing condition.” A pre-existing condition is a health problem that developed before you joined the health care plan. This means that most health plans cannot turn you down or charge you more for health insurance if you have a pre-existing condition.

This does not apply to grandfathered individual health plans. For more information about grandfathered health plans, click here.

What if I am a Young Adult?

If you are 26 years old or younger, you can stay on your parent’s health care plan. This is called dependent coverage. It doesn’t matter whether you are married, single, in school, or working.

If you are under 30 years old, you can get catastrophic insurance. Under the ACA, catastrophic insurance will pay for three primary care visits and preventive care. After you meet a deductible ($5,950 for an individual and $11,900 for a family), catastrophic insurance will also cover 60% of essential health benefits. For more information about essential health benefits, click here.

Where Can I Find More Information?

Brief information about insurance options if you do not have a job. At the bottom of the page, there is also a list of other frequently asked questions: https://www.healthcare.gov/what-are-my-health-coverage-options-if-im-unemployed/

The Home Page for the Health Insurance Marketplace: http://www.healthcare.gov/marketplace/index.html

A short story about Lupita, a woman who does not have health insurance: https://www.healthcare.gov/blog/lupita-s-story-i-don-t-have-insurance/