Question 1

What happens if I choose to go without insurance?

Accepted Answer

Starting in 2019, President Trump has ammended the health care reform law to waive all tax penalties for 2019 forward. If you go without insurance prior to this you will be subject to a $695 penalty per person (up to a maximum of $2,085), $347.50 per child or 2 1/2% of the household income, less the taxpayer's filing threshold amount.    This does mean you will have to pay a penalty if you choose to go without insurance for 2018.

Question 2

What would my penalty be?

Accepted Answer

You may use the payment estimator here: https://taxpayeradvocate.irs.gov/estimator/isrp/estimator.htm

Question 3

What is the difference between individual and family health insurance?

Accepted Answer

Individual and family health insurance is a type of health insurance coverage that is available to an individual (one person) or a family (more than one person within the family). This is different than a group health insurance policy which provides health insurance coverage to owners and their employees of a business or organization. If offered, most people would prefer to have their employer provide group health insurance coverage. The truth is, not all employers offer it. If health insurance benefits are not offered, then an individual or family plan is another option. There are many affordable individual and family plans available to fit any budget. Keep in mind, the more you can afford, the richer the benefit.

Question 4

What kind of individual and family plans are available?

Accepted Answer

Individual and family health insurance plans are either “indemnity” or “managed-care” plans. The major differences include choice of healthcare providers, out-of-pocket costs and how bills are paid. Indemnity plans offer a broader selection of healthcare providers than managed care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).   There are several different types of managed care health insurance plans. These include HMO, PPO, and POS plans. Managed care plans typically use provider networks. These providers within a network agree to perform services for patients at pre-negotiated rates and most of the time will submit the claim to the insurance company for you. This means that you will have less paperwork and lower out-of-pocket costs.

Question 5

How does a PPO plan work?

Accepted Answer

With a PPO (Preferred Provider Organization) plan, you’ll be encouraged to use the insurance company’s network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to you at a discounted rate. You will not be required to choose a primary care physician (like you would with an HMO plan) but you should be proactive in only seeing providers within the network to avoid extra out of pocket expense.   You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or be required to cover a certain percentage of the total charges for your medical bills. With a PPO plan, services rendered by an out-of-network provider will ultimately cost you extra out of pocket expenses. We cannot stress enough the importance of staying within the network to minimize your medical premium dollars spent.

Question 6

How does an HMO plan work?

Accepted Answer

An HMO (Health Maintenance Organization) plan provides rich benefits. They offer lower out-of-pocket healthcare expenses. They offer less flexibility in the choice of providers than other health insurance plans. You will be required to choose a primary care physician (PCP) when you apply for an HMO plan. You will be required to visit your PCP if and when you need medical attention. If you need to see a specialist, you will need to be referred by your PCP. You may have no coverage provided for services rendered by an out-of-network provider.

Question 7

How does an HSA work?

Accepted Answer

Legislation establishing Health Savings Accounts (or “HSAs”) took effect on January 1, 2004. HSAs and HSA-compatible health insurance plans are becoming more and more popular. Here are the basics:   An HSA is a savings account that may be used in conjunction with an HSA-compatible high deductible health insurance plan (HDHP) to pay for qualifying medical expenses that are established by the federal government. Not all high deductible health plans are HSA compatible.   Choosing an HSA-compatible health insurance plan may help you save money. The monthly premium on an HSA-compatible high deductible plan is less expensive than the monthly premium on a lower-deductible health insurance plan.   Contributions to an HSA may be made at any time subject to certain annual limits established by the federal government.   Funds in the HSA may be used at your discretion for non medically qualified expenses but you will be subject to a penalty. Record keeping is essential. Unused funds remain in the HSA account and accrue interest year-to-year and are tax-free.

Question 8

How does the health insurance exchange impact me? (2011)

Accepted Answer

Small businesses often choose health insurance policies for their employees based on the cost. Some businesses may even choose not to provide health policies because they’re simply too expensive. Enter the new “health insurance exchanges,” which are set to become fully online and operational in 2014.   Health insurance exchanges are mandated under the Patient Protection and Affordable Care Act signed into law by President Barack Obama on March 23, 2010.   Of course, the constitutionality of the healthcare reform law is still at issue. The Supreme Court is set to hear arguments next year.   But if all goes according to the Obama Administration’s plan, what should your small business expect — and what exactly are “health insurance exchanges”?   Health insurance exchanges are state-run. The term isn’t too descriptive, but health insurance exchanges are essentially state-wide marketplaces where individuals and small businesses can shop and purchase health insurance coverage.   It’s possible the exchanges will result in lower costs. One of the goals of the health insurance exchanges is to foster transparency, and hopefully lower costs of insurance for individuals and businesses.   Businesses still won’t be mandated to provide insurance to employees. Remember, if the healthcare law is passed, individuals, not businesses, will be mandated to purchase coverage. But businesses could face fines in 2014 if they employ 50 or more workers and fail to provide coverage to those who work 30 or more hours a week.   There may be tax credits you can use. Certain firms will qualify for tax credits of up to 50% of their contribution if they provide health insurance. These tax credits, however, are mostly temporary. The specific amount you can claim will depend on how many employees you have, and their average salary, according to The Wall Street Journal.   The creation of health insurance exchanges to come 2014 will likely have an impact on small businesses. Recent surveys have even indicated that some employers are receptive to the idea of purchasing coverage through small business exchanges. Where do you stand on the issue?   _

Question 9

My spouse has insurance through their employer, but it is too expensive to add me on. Can I enroll in Covered California?"

Accepted Answer

The short answer is probably not. However, as with most things in the healthcare exchange the answer is not cut and dry.   Most health plans offered by employers are affordable and offer minimum value. A health plan meets minimum value requirements if it is designed to pay at least 60% of the total cost of medical services for a standard population and includes substantial coverage of inpatient hospital and physician services. Employees offered job-based coverage that provides minimum value and is considered affordable aren’t eligible for a premium tax credit.   Employer insurance is considered affordable under the ACA if the employee’s share of the premium for the lowest priced plan available that would cover the employee only — not the employee’s family — is 9.56% or less of their household income. Employees offered job-based coverage that’s affordable and provides minimum value are not eligible for a premium tax credit if they purchase a plan through Covered California.

Question 10

What happens if I make more income than what I report to Covered California?

Accepted Answer

If you stated that your income would be a certain amount, and then you received premium assistance based on that amount, but your income turned out to be lower than you stated, you may have been entitled to more premium assistance than you received, and you will receive the balance as a tax credit when you file your tax return. If your income turned out to be higher than you projected, then you likely received too much premium assistance. If so, you will have to pay back the difference at tax time, up to a certain limit.   The table below shows the repayment limits. >

Question 11

When can I sign up for dental insurance?

Accepted Answer

You can apply for dental insurance at any point during the year. Most carriers have a cut off date during the month in order to have an effective date for the first of the following month. Delta Dental plans are available to review here.