Fix My Finances: Most common questions about ACA insurance

Melody Hahm
Senior Writer

Welcome to Fix My Finances, a Yahoo Finance personal finance series. Each episode, we take a look at one viewer’s financial state of affairs and offer advice, insight and information on a variety of issues, including how to save more, spend less and pay off lingering debt.

Today’s episode is Part 2 of your questions about the Affordable Care Act. Yahoo Finance Reporter Melody Hahm speaks with Ralph Tornello, a benefits consultant with NY-based Ladmar Associates, specifically about enrolling in the ACA health exchanges.

Let’s get to those questions.

Is it too late to sign up?

Yes … but maybe not!

Under the Affordable Care Act, Americans can sign up for health insurance on their state’s marketplace exchange or individual marketplace only during annual periods of open enrollment. Unfortunately, the enrollment period for 2017 has ended. The 2018 open enrollment begins on November 1, 2017. If you missed this year’s deadline, you’re likely out of luck for 2017.

However, there are some exceptions that will allow enrollment outside of that period. For example, if you lose your job — and your employer-sponsored health coverage — don’t worry. That type of event “opens up a special enrollment period,” says Tornello, “[in which] you have exactly 60 days to enroll in other coverage.”

Besides job loss, other events may allow you to enroll in a marketplace plan for the rest of 2017. Take the questionnaire on Healthcare.gov to see if you qualify.

If I miss open enrollment or the special enrollment period, will I be fined? If so, when?

The Affordable Care Act requires most Americans to have health insurance, and those who don’t have to pay a penalty. That goes for people who miss out on the open enrollment period.

So if you lose your job and don’t get coverage in the allotted time, “You will pay a penalty,” says Tornello. But, he says, “You have to have three consecutive months without coverage for that penalty to be enforced.”

The penalty amount is calculated two different ways — a percentage of your household income or a per-person fee, and you pay whichever total is higher. The per-person penalty is $695 for adults and $347.50 for children under 19. However, the total for a family cannot exceed $2,085.

You pay the fee when you file your federal tax returns for the year you were not insured.

What tax credits are there associated with signing up through the ACA’s Health Insurance Marketplace?

Families with low to moderate income can receive a tax credit if they purchase health coverage through the Health Insurance Marketplace. For a single person to qualify, he or she has to make under $47,080 a year. For a family of four, the cut off is $97,000.

Tornello advises those who think they qualify to check out Healthcare.gov. The site will take you to the exchange in your state and a subsidy calculator where you can calculate what your subsidy should be.

“It’s very important to be accurate with your income,” Tornello says. “You will pay back what you are not eligible for straight through your tax refund.”

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