Making your way through the healthcare.gov maze, filled with unclear acronyms, fine print, and too many loopholes to count, can lead to frustration and defeat. And with Open Enrollment closing in just a few more days (December 15), your angst may be at all-time high.
It’s totally understandable to think: What if I skipped out on this whole health insurance thing? It’s expensive and complicated as heck. Plus, you may be relatively healthy, and only visit the doctor once or twice a year, if at all. If anything, you could just pay out-of-pocket if you really needed something.
We’ve been there and we get it. Health insurance has good intentions—it helps us take better care of ourselves—but the process of getting it (and truly understanding what you’re getting) seems to chuck those good intentions right out the window.
The good news? You don’t have to figure out health insurance alone. Let’s talk about a few reasons health insurance—despite feeling like a royal pain—is always a good idea, and what resources are at your disposal to help you navigate it.
Health insurance is smart…and required by law
First and foremost: Getting coverage ensures you’ll have support and assistance if something unpredictable happens. It protects you and your family in the face of unexpected illnesses or injuries. Without insurance, one car accident or slip on the ice could cost you thousands in medical bills and could even require you to file for bankruptcy, depending on the situation.
Plus—and this is a big one—you’re legally required to get health insurance if you can afford a plan.
You read that last part right. In 2014, health insurance became mandated by federal law under the Affordable Care Act. If you don’t have qualified health insurance for three full, consecutive months or more (assuming you can afford it), you may owe some cash money come tax season. If your annual gross income is at least $10,350 ($20,700 for married, joint filings) you are legally required to get health insurance.
How does this penalty work?
Here are a couple of examples.
Emma Peters, a 28-year-old paralegal in Lexington, KY, lost her employer-based health insurance on March 30. “I had to go uninsured for all of April, May, and most of June,” she says. “But I secured a new job in June, and my new employer’s insurance kicked in on June 30.”
Emma is safe from any penalty, since she technically had insurance in the month of June (even if it was just for one day).
Tatiana Levy, a 32-year-old graduate student in Dallas, TX, however, lost her employer-based insurance on August 30. She went uninsured for all of September, October, and November and then enrolled in a marketplace insurance plan that started on December 1.
Tatiana will have to pay a penalty, since she wasn’t insured for three full months. “I honestly had no idea there was a penalty for being uninsured for this amount of time. No one really talks about healthcare being required by law or the fees.”
Let’s talk ca$h penalties
If you decide to go without healthcare coverage for three full months or more, the government will calculate an annual penalty using one of two scenarios:
Scenario 1: 2.5 percent of your household income
Scenario 2: $695 per uninsured adult and $347.50 per uninsured child in your household, up to a maximum of $2,085.
You pay whichever one of these scenarios ends up costing you more. And you pay for the months you did not have coverage. If you had coverage for part of the year—say, five months out of 12—then you’d owe 7/12 of the annual penalty fee because you were uninsured for seven months.
So how do you Nav. the marketplace?
There are a few places (and people—yes, real humans) you can turn to if you want assistance applying for health insurance.
If you’re choosing to enroll in a marketplace plan, you can speak to a government-trained healthcare counselor to guide you through the process. If your state has its own marketplace, you can reach out to someone who specializes in your state’s health plan options.
You can also use a licensed private health insurance broker. Think of them as an intermediary between you and your health insurance plan. They do not represent or work on behalf of health insurance companies—only their clients. Health insurance brokers can objectively help you make the best decision for your needs.
If you go this route, you won’t have to pay them a fee for their services. Instead, your broker will keep a percentage of your monthly premium as payment.
Prefer self-service resources? You may like joany.com, a digital health insurance brokerage, that guides you through the application process by having you complete their simple questionnaire. Then, the product presents you with ideal plans based on your answers. You can even chat online with their support team to address your questions. Again, there’s no fee. Your health plan will pay Joany an average of $12 each month if you use the tool to get health insurance.