Everyone Must Have Health Coverage

Beginning March 31, 2014, almost every American must have health insurance or pay a fee through their taxes. You can get coverage through an employer, from the government, or by purchasing an individual or family plan. If you qualify for Medicare, visit our Medicare page.

In 2014, you are guaranteed coverage in a health plan, regardless of health status such as a pre-existing condition or other factors. Being sick will not keep you from getting coverage, and your health condition is covered when your plan becomes effective.

Depending on your situation, a subsidy may be available to help make coverage easier to afford. This savings is based on your household income and family size.

A New Way to Buy Health Insurance

If you don’t have health insurance through your employer, you can buy it directly from a health insurance exchange, also known as a marketplace. If you have job-based health insurance you like, you can keep it – but you may be able to find coverage in an exchange if you want to.

Please note: Many employers pay part of group health plan premiums for their employees. If you choose a plan from an exchange, your employer probably won’t pay for your premiums and you may not qualify for a subsidy. You should think about this carefully when looking at plans in an exchange. If you have questions, we can help.

Each state is required to have its own exchange or to participate in the federal exchange. There are also private exchanges where individuals can find plans that fit their specific needs.

Exchanges are competitive marketplaces that allow individuals and small businesses to look for and buy affordable health coverage – kind of like a health insurance mall. Through an exchange, you will be able to compare plans, benefits, and premiums.

Private vs. Public Exchanges

Private health exchanges are operated by insurance brokers or insurance companies, and these exchanges give you another way to shop for a variety of medical plans as well as supplemental insurance products like disability, dental, and vision plans. Both private and public exchanges offer online services where it’s easy to compare plans, shop for the best rates, and even enroll.

Many private exchanges also offer decision support services that help you find the plan that best suits your family’s needs. Support services often include live advisors who can answer questions and provide assistance during open enrollment. You can also use private exchanges to purchase an individual or family plan.

While it’s up to you which exchange to use, it’s worth looking into the personalized services offered by a private exchange. Simply Covered gives you access to licensed benefits advisors who can help you compare your public exchange and private exchange options. Visit our Find Coverage page to get started.

Switching from a Pre-existing Condition Insurance Plan

A pre-existing condition insurance plan (PCIP) is from a program that offers a health coverage option for people who have been uninsured for at least six months, have a pre-existing health condition, and have been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company. The health care reform law created this program as a temporary way for people with pre-existing conditions to get health coverage until 2014 when health insurance companies can no longer deny coverage due to a pre-existing condition.

IMPORTANT: If you have coverage under this program, it will generally end on December 31, 2013, and PCIP will not pay for services you receive after this date. You must find an individual plan by December 15, 2013 to avoid a gap in coverage. We can help you find a plan.

Key Dates to Know

Be aware of these important dates and mark them on your calendar:

  • October 1, 2013 – Open enrollment begins
  • December 15, 2013 – Last day to enroll in a plan if you have federal PCIP coverage
  • December 31, 2013 – PCIP coverage ends
  • January 1, 2014 – Health coverage begins
  • March 31, 2014 – Open enrollment ends

After open enrollment ends on March 31, 2014, you can’t get health coverage through the public marketplace until the next open enrollment period begins in the fall, unless you have a qualifying life event, such as moving to another state, change in your income, or change in your family size (having a baby, getting a divorce, etc.).

The Price of Non-compliance

If you and your dependents don’t have health coverage after open enrollment ends in 2014 and beyond, you will have to pay a fee when you file your taxes.

Fees for Non-compliance
Year Per Person Flat Fee Percentage of Income
2014 $95  or 1%
2015 $325 or 2%
2016 $695 or 2.5%

Fee is the greater of the two amounts; dependents under age 18 will be assessed at a rate of half the standard fee.

IMPORTANT: A person who pays the fee won’t get any health coverage. They will still be responsible for paying the entire cost of their medical care.