Q&A: the new health-insurance requirement

The federal Affordable Care Act requires everyone to have health insurance. Here are some answers to frequently asked questions:

Q: What’s the deadline?

A: It’s March 31, but officials with the state’s online health insurance shopping site, Washington Healthplanfinder, are urging people to not wait until then to try to sign up. At the last minute, there could be long waits, either online or when seeking help over the phone.

The website is www.wahealthplanfinder.org. Click on the customer-support link for help. Or call 1-855-923-4633.

Individual health plans can also be purchased from insurance brokers. Go to the wahealthplanfinder.org website, click on the link for help and then look for the “find a broker” link.

Q: When would the insurance start?

A: For coverage effective April 1, customers must sign up and make an initial payment for private health insurance by 5 p.m. March 23. For coverage effective May 1, signups must be completed by 11:59 p.m. on March 31.

Q: I’m on my parents’ health insurance plan. How long can I keep it?

A: Until you turn 26.

Q: What if I don’t sign up?

A: You might have to pay a fine. There are two ways it could be calculated. The formula used is whichever is the higher amount: 1 percent of your yearly household income for those earning $10,150 or more for an individual; or $95 per person for the year plus $47.50 per child younger than 18. The maximum a family would pay is $285.

You also would be responsible for the cost of medical care if you are injured or sick, which can be expensive.

Q: How would the penalty for not having insurance be paid?

A: The IRS would take the penalty amount out of your tax refund — if the person is going to receive a tax refund — according to the state Insurance Commissioner’s Office. If they weren’t going to receive a tax refund, then nothing will happen.

Q: How will the government know I don’t have health insurance?

A: When people fill out their federal tax returns, they’ll have to provide proof of insurance, such as payroll deductions. If a person checks the box saying they have insurance but don’t provide proof of insurance, the IRS will probably treat the person as if they didn’t have insurance. They’d then take the penalty out of the person’s refund, if the person is going to get a refund, according to the state Insurance Commissioner’s office.

Q: How much will I pay for health insurance?

A: It depends. There’s help for people who meet income guidelines. Someone making up to $15,856, or a family of four making up to $32,499, might qualify for Apple Health, the state’s federally subsidized Medicaid plan.

A single adult can earn up to $45,960 and get a subsidy for private health-care insurance. A family of four can make up to $94,200 and qualify for financial help.

It also depends on which benefits you opt to include in your insurance, such as how much you pay out of pocket before insurance starts paying part of the bill.

Q: What if I don’t meet the March 31 deadline?

A: In most cases, those buying private health insurance would have to wait until the next enrollment period in November. There are some exceptions — if you lost your job or moved out of the geographic area covered by health insurance. Some plans limit which counties they’re available in.

There’s no similar deadline for people signing up for Apple Health, the state’s Medicaid plan. It continues throughout the year.

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