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ACA/Obamacare Q and A

By Rick Howie

Health Exchange Navigator


Q: Did I miss the open enrollment deadline?
A:  Yes, the deadline for 2016 coverage for all qualified health plans was January 31, 2016 and there was no extension granted this year.

Q: What are the tax penalties for not having health insurance?
A:  For tax year 2015, $325 per adult plus $162.50 per child, pro-rated (up to a maximum of $975 per family) or 2% of annual household income, whichever is greater.

A:  For tax year 2016, the penalty will jump to $695 per adult plus $347.50 per child, pro-rated, (with a maximum of $2,085 per family) or 2.5% of family income, whichever is greater.

Q: Can I still get medical insurance?
A: This depends:

  • If your projected 2016 income is below $23,540 (single), $31,860 (couple),  $40,180 (couple + child), $48,500 (family of 4) you may qualify for Medicaid or an Essential Plan.
  • Children or pregnant women – yes.
  • If you meet any of the “Special Enrollment Exceptions” listed below you may be eligible:

Special Enrollment Exceptions:

Individuals and families can enroll in a private health plan after January 31, 2016 if they have had a Qualifying Life Event.

Qualifying Life Events Eligible for a Special Enrollment Period:

  • Loss of minimum essential coverage
  • Marriage or domestic partnership, birth, adoption, or placement in foster care
  • Becoming a citizen, national, or lawfully present individual
  • For those already enrolled in a QHP (qualified health plan), becoming newly eligible or ineligible for tax credits; or eligible for a different amount of cost sharing reductions (ie job loss)
  • Permanent move to NY, or permanent move from one county to another within NY
  • Qualified Health Plan violated a provision of its contract
  • American Indians can enroll or change plans one time per month throughout the year

Not considered a Qualifying Life Event:

  • Voluntarily dropping other health coverage
  • Being terminated for not paying your premiums
  • Losing coverage that is not minimum essential coverage,in accordance with HHS guidelines

What numbers do I call:

  • Customer Support Center at 1-855-355-5777 for more information and help applying.
  • Westchester Disabled On the Move (WDOM) – 914-968-4717 for face to face Navigator assistance in applying.

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