Myth Busting: Health Coverage Fact vs. Fiction

Dad and daughter flyingFact or myth: The penalty for not having insurance in 2014 is only $100.

MYTH. The penalty is $95 or 1% of income, whichever is higher.

The penalty in 2014 is calculated one of 2 ways. If you or your dependents don’t have insurance that qualifies as minimum essential coverage you’ll pay whichever of these amounts is higher:

  • 1% of your yearly household income. (Only the amount of income above the tax filing threshold, $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
  • $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.


Fact or Myth: The penalty will be increasing.

FACT. In 2016 the penalty will be 2.5% of yearly income or $695, whichever is higher. [Source]


Fact or Myth: If I get hurt I can just visit the marketplace and buy insurance to get treatment.

MYTH. You can only purchase insurance on the Connect for Health Colorado marketplace during specific open enrollment periods. If you get injured and try to purchase insurance during a non-enrollment period, you will not be able to buy from the marketplace. The next open enrollment period is November 15, 2014 to February 15, 2015. [Source]


Fact or Myth: If I choose to pay the penalty and not purchase insurance, I won’t have to pay for certain medical costs.

MYTH. If you pay the penalty you will still be uninsured and have to pay 100% of medical costs out of your own pocket. [Source]


Fact or Myth: It will cost more or I won’t be able to get insurance if I have a pre-existing condition.

MYTH. Under the Affordable Care Act an insurance company can’t turn you down, charge more or refuse to cover treatment for your pre-existing condition.  [Source]


Fact or Myth: I will have to disclose personal medical information and history to purchase insurance.

MYTH. All you will be asked is if you use tobacco and if you are pregnant. [Source]


Fact or Myth: Under the Affordable Care Act I will not be able to choose my doctor.

Maybe. You can still choose your doctor with plans sold through the Connect for Health Colorado marketplace, but as before if you change coverage your previous doctor may not be available through the new coverage. You can search for specific doctors at the marketplace and see what coverage they accept in order to help you choose a coverage plan that is right and personalized for you.  [Source]


Fact or Myth: Certain preventive care such as immunizations, contraception, STD testing, mammograms, pap smears, etc. will be free under the Affordable Care Act.

FACT. The Affordable Care Act provides various preventive care measures that will cost you nothing if you are insured. [Source]


Fact or Myth: Premium rates will be calculated based on age, region of state you live, and tobacco use.

FACT. These are the only three factors that go into premium rate calculation. Gender, pregnancy status, and medical history will not be considered in calculating these rates. [Source]


Fact or Myth: Small Businesses (2-50 full-time employees) will be required to provide health insurance to employees or face a penalty.

MYTH. This is true for large businesses (50+ full time employees), and although small businesses are encouraged to provide insurance and the government offers credits and subsidies to help make it more affordable to do so, small businesses are not required to provide insurance to employees. [Source]


Fact or Myth: My partner will be able to get coverage if we are in a common law marriage or civil union.

FACT. This is true but domestic partnerships will not qualify your partner for coverage. [Source]


Fact or Myth: Average monthly premiums in the individual market in Colorado are lower than the national average.

FACT. In 2010 it was reported that the average monthly premium for the individual market in Colorado was $194 while the national average was $215. [Source]