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The Health Insurance Mandate: Get Covered or Pay a Penalty

The Health Insurance Mandate: Get Covered or Pay a Penalty

What to Know

Health insurance, or health coverage, helps pay for doctor visits, hospital services and medications. You may get health coverage through:

  • Your employer
  • A government program like Medicaid, Medicare or Veterans Health Care program
  • A health insurance company directly
  • A health insurance plan chosen on the Health Insurance Marketplace (www.healthcare.gov)

The coverage your plan offers will determine what doctors and hospitals you can use and how much you have to pay. Check with your insurance company to better understand what services and doctors your plan will pay for and how much each visit will cost (your copay).

Health Coverage Requirement

The “individual mandate” provision of the Patient Protection and Affordable Care Act (ACA) requires that people obtain health insurance or pay a federal tax penalty. If you currently have coverage from Medicare, Medicaid, through your employer, or you purchase coverage for yourself, you are considered covered and will not pay a tax penalty. Furthermore, you may be exempt from paying the penalty for not having coverage if you have a financial hardship or if it would cost more than 8% of your income to purchase coverage.

For more information on the health coverage requirement, visit: www.healthcare.gov/taxes or www.irs.gov/aca.

What to Do

Tips on How to Shop for Health Insurance

Health insurance for individuals and families is only sold during an annual open enrollment period. You can shop for coverage in the Health Insurance Marketplace (www.healthcare.gov) or outside in the overall market. The Health Insurance Marketplace is a website where individuals and small businesses may choose to shop for and compare health coverage.

How to Buy Health Coverage:

  • Through the Health Insurance Marketplace. Visit: www.healthcare.gov or call 800-318-2596.
  • Directly from an insurance company.
  • With the help of a licensed agent. Agents can help you buy coverage off the Marketplace and many can help you buy coverage on the Marketplace.
  • With the help of a federally trained navigator or certified application counselor. Navigators and certified Application Counselors can help you sign up for a Marketplace plan with no cost to you.
  • From an online health insurance seller.

Things to Consider When Shopping for Coverage:

  • Do your best to balance the cost (monthly premium) of a policy with the protection it offers.
  • Determine what you will have to pay for covered services in a deductible, coinsurance, copayments, and out-of-pocket limit.
  • Determine what benefits are covered without having to meet the deductible in advance.
  • Determine the access to care.

Healthy Michigan PlanHealth Insurance Paperwork

Some Michigan residents may be eligible for the Healthy Michigan Plan, a health coverage program that began on April 1, 2014. To be eligible for the Healthy Michigan Plan, you must be:

  • Ages 19-64
  • Not currently eligible for Medicaid
  • Not eligible for or enrolled in Medicare
  • Not pregnant when applying for the Healthy Michigan Plan
  • Earning up to 133% of the federal poverty level (the federal poverty level is adjusted annually).
  • A resident of Michigan

For more information, visit www.HealthyMichiganPlan.org or call 855-789-5610.

Where to Turn

Helpful health insurance websites:

www.healthcare.gov
www.michigan.gov/hicap
www.michigan.gov/difs
www.HealthyMichiganPlan.org
www.michigan.gov/MIBridges
www.irs.gov/aca
www.michagent.org