- Are children subject to the individual shared responsibility provision?
Yes. Each child must have minimum essential coverage or qualify for an exemption for each month in the calendar year. Otherwise, the adult or married couple who can claim the child as a dependent for federal income tax purposes will generally owe a shared responsibility payment for the child. Read more about the shared responsibility provision and how to apply for an exemption.
- Are residents of U.S. territories subject to the individual shared responsibility provision?
All bona fide residents of the United States territories are treated by law as having minimum essential coverage. They are not required to take any action to comply with the individual shared responsibility provision. For more information click here.
- Are senior citizens subject to the individual shared responsibility provision?
Yes. Senior citizens must have minimum essential coverage or qualify for an exemption for each month in a calendar year. Both Medicare Part A and Medicare Part C (also known as Medicare Advantage) qualify as minimum essential coverage. Read more about the shared responsibility provision and how to apply for an exemption.
- Are U.S. citizens living abroad subject to the individual shared responsibility provision?
Yes. However, U.S. citizens who are not physically present in the U.S. for at least 330 full days within a 12-month period are treated as having minimum essential coverage for that 12-month period. In addition, U.S. citizens who are bona fide residents of a foreign country (or countries) for an entire taxable year are treated as having minimum essential coverage for that year.
U.S. citizens who meet neither the physical presence nor residency requirements will need to maintain minimum essential coverage, qualify for an exemption or make a shared responsibility payment for each month of the year. For this purpose, minimum essential coverage includes a group health plan provided by an overseas employer. One exemption that may be particularly relevant to U.S. citizens living abroad for a small part of a year is the exemption for a short coverage gap. This exemption provides that no shared responsibility payment will be due for a once-per-year gap in coverage that lasts less than three months. For more information click here.
- Can I be covered under my parents’ plan if I’m married?
See: Healthcare.gov
- Do I have to be covered for an entire calendar month to avoid the shared responsibility payment liability for not having minimum essential coverage for that month?
No. You will be treated as having minimum essential coverage for a month as long as you have coverage for at least one day during that month. For more information click here.
- Do I have to live in my parents’ home to be covered as a dependent under their policy?
See: Healthcare.gov
- Do my parents have to claim me as a tax dependent for me to be on their health plan to age 26?
No. You do not need to be a tax dependent of your parents to continue to be covered as a dependent on their health plan. For more information about coverage for young adults click here.
- Do my spouse and dependent children have to be covered under the same policy or plan that covers me?
No. You, your spouse and your dependent children do not have to be covered under the same policy or plan. However, you, your spouse and each dependent child for whom you may claim a personal exemption on your federal income tax return must have minimum essential coverage or qualify for an exemption, or you will owe a shared responsibility payment when you file a return. For more information click here.
- Does the decision to phase out non-ACA compliant health plans impact grandfathered plans?
No. Grandfathered plans, as defined by the Affordable Care Act (ACA), are plans with an effective date prior to March 23, 2010, before the ACA became law. Grandfathered plans can continue as long as the insurance company does not make any significant changes to the plan or its benefits.
- How do I apply for an exemption from the fee for not having health coverage?
See Connect for Health Colorado for more information about how to apply for an exemption to the individual mandate in Colorado.
- How do I know if I qualify for expanded Health First Colorado (Colorado’s Medicaid Program) coverage?
See: Get Covered
- How do I prove that I had health coverage and satisfied the mandate?
- How safe is my personal information? What policies exist to keep my information secure?
Get more information regarding privacy policies and laws.
- I am a health care provider and my patients have asked me about buying health insurance through the Connect for Health Colorado marketplace. Where can I find out more information about the marketplace?
Visit Connect for Health Colorado for more information about buying insurance through the marketplace.
- I am a retiree and I am too young to be eligible for Medicare. I receive my health coverage through a retiree plan made available by my former employer. Is the retiree plan minimum essential coverage?
Yes. Retiree health plans are generally minimum essential coverage. Get more information.
- I currently have a medical discount card or am enrolled in a medical discount program. Will that satisfy my individual responsibility to have health insurance?
No. Programs that only offer discounts on medical services do not meet minimum essential coverage and do not qualify as health insurance coverage. If you have only these types of coverage, you may have to pay the fee. Get more information from Healthcare.gov and the Colorado Division of Insurance.
- I’m a young adult and I need health insurance. What are my coverage options?
A number of options may be available to you:
- If your monthly income is below about $1,250 a month, you may newly qualify for Health First Colorado (Colorado’s Medicaid Program) beginning in January 2014. To find out if you qualify for free or low cost health insurance through Health First Colorado click here.
- If you make more than about $1,250 a month, then you may qualify for financial assistance to help you buy health insurance through the Connect for Heath Colorado marketplace. To find out if you qualify click here.
- If your parents have health insurance that offers dependent coverage, you can join (or stay on) their health insurance policy as a dependent and remain covered until your 26th birthday. Get more information.
- Also, if you are a student, you may be able to enroll in student health offered through your college or university.
- I’m an American college student and I plan to study abroad next semester. Am I required to have U.S. health insurance while I’m living in another country?
Yes, unless you qualify for another exception. If you are a student temporarily living abroad for part of the year, and don’t qualify for any other exceptions, you would be required to have health insurance or else pay a penalty. To find out more about the exemptions to the individual mandate click here.
- I’m uninsured. Am I required to get health insurance coverage in 2014?
- If I receive my coverage from my spouse’s employer, will I have minimum essential coverage?
Yes. Employer-sponsored coverage is generally minimum essential coverage. If an employee enrolls in employer-sponsored coverage that provides minimum value for himself and his family, the employee and all of the covered family members have minimum essential coverage. For more information click here.
- If my income is so low that I am not required to file a federal income tax return, do I need to do anything special to claim an exemption from the individual shared responsibility provision?
No. If you are not required to file a federal income tax return for a year because your gross income is below your return filing threshold, you are automatically exempt from the shared responsibility provision for that year and do not need to take any further action to secure an exemption. If you are not required to file a tax return for a year but file one anyway, you will be able to claim the exemption on your tax return. For more information click here.
- On what grounds can I apply for a hardship exemption to the individual mandate?
- What does the Affordable Care Act mean for clients served directly by the Colorado Department of Human Services at 24-hour facilities including the Regional Centers, Mental Health Institutes, and youth facilities?
Clients at the Colorado Regional Centers for People with Developmental Disabilities receive health care coverage from Health First Colorado (Colorado’s Medicaid Program). They and their families do not need to change what they are currently doing.
Individuals at the Mental Health Institutes at Ft. Logan and Pueblo receive health care coverage in different ways, including under Health First Colorado, Medicare or private health insurance. In some cases, the state covers the costs of care. Nothing will change for individuals currently residing at the Mental Health Institutes.
Individuals who do not have coverage when discharged from the Mental Health Institutes may benefit from the Affordable Care Act. Some individuals might qualify for Health First Colorado. For others, it will reduce roadblocks so that they will be able to buy insurance without the worry of denial due to a pre-existing condition, such as mental illness, on the private market.
Youth in the care and custody of the Division of Youth Services receive health care, including mental health care, from state credentialed medical personnel. Youth in community facilities are Health First Colorado-eligible and receive care from a network of medical professionals. Nothing will change for youth at Division of Youth Corrections or in a community facility.
- What happens if I do not have minimum essential coverage or an exemption, and I cannot afford to make the shared responsibility payment when filing my tax return?
The IRS routinely works with taxpayers who owe amounts they cannot afford to pay. The law prohibits the IRS from using liens or levies to collect any individual shared responsibility payment. However, if you owe a shared responsibility payment, the IRS may offset that liability against any tax refund that may be due to you. Get more information.
- What is the penalty if I do not have health insurance coverage?
- What kind of notices can consumers expect regarding non-ACA compliant health insurance plans?
Insurance companies are required to provide a notice of termination at least 90 days before the expiration of the plan, or 180 days if the company is leaving the Colorado insurance market. The notice must contain information about any ACA-compliant plans the insurance company offers, the availability of Affordable Care Act (ACA) plans through Connect for Health Colorado, and the consumer’s ability to shop for an ACA plan offered by any other insurance company. Insurance companies cannot automatically enroll, or “map,” a policyholder into a new plan from their company.
- What qualifies as a short coverage gap?
In general, a gap in coverage that lasts less than three months qualifies as a short coverage gap. If an individual has more than one short coverage gap during a year, the short coverage gap exemption only applies to the first gap. For more information click here.
- What type of insurance satisfies the individual responsibility mandate to have health insurance?
To avoid a penalty, most Coloradans will need to have health insurance coverage beginning in 2014. Your health insurance coverage must provide minimum essential coverage. If you are covered by any of the following types of insurance in 2014, you satisfy the individual responsibility mandate to have health insurance and will not have to pay a penalty:
- Health First Colorado (Colorado’s Medicaid Program)
- Child Health Plan Plus (CHP+)
- Medicare
- Any plan purchased through the Connect for Health Colorado marketplace, or any individual insurance plan you already have.
- Any employer plan, including COBRA, with or without “grandfathered” status. This includes retiree plans.
- TRICARE (for current service members and military retirees, their families, and survivors)
- Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
- Peace Corps Volunteer plans
Other plans may also qualify. Ask your health insurance provider.
- Who is exempt from having insurance beginning in 2014?
- Will Health First Colorado (Colorado’s Medicaid Program) count as coverage so I can avoid a penalty?
- Will I have to do something on my federal income tax return to show that I had coverage or an exemption?
The individual shared responsibility provision goes into effect in 2014. You will not have to account for coverage or exemptions or to make any payments until you file your 2014 federal income tax return in 2015. Information will be made available later about how the income tax return will take account of coverage and exemptions. Insurers will be required to provide everyone that they cover each year with information that will help them demonstrate they had coverage beginning with the 2015 tax year. For more information click here.
- Will individuals and small employers losing their non-ACA compliant plans be able to enroll in health insurance plans outside of open enrollment?
Yes. For individuals, the loss of existing coverage is considered a triggering event that makes a person eligible for a special enrollment period to select new coverage, either through Connect for Health Colorado, an insurance broker, or directly with an insurance company.
- Most individual plans are already aligned with the calendar year for health insurance, meaning they will expire at the end of 2015. Consumers in these plans can select a new plan during the next open enrollment period, which begins November 1, 2015, and ends January 31, 2016.
- Individuals who have policies that will expire in the middle of the year can enroll in an Affordable Care Act (ACA) plan once they receive their notice of termination from their carrier. They will want to make sure the new plan will be effective the day following the termination date of their current plan to avoid a gap in coverage.
- Individuals cannot simply drop their plan because they know it will terminate at some point this year. Voluntarily dropping coverage is not a triggering event that will allow someone to enroll outside of open enrollment. Individuals who voluntarily drop their current plan will have to wait until the next open enrollment to enroll in coverage. That coverage would begin January 2016.
Small businesses may purchase plans anytime throughout the year, without waiting for an open enrollment period. When their existing plans terminate, they can buy new plans either through Connect for Health Colorado, an insurance broker, or directly with an insurance company. The annual open enrollment period for their employees will be based on the plan’s effective date.
- Will Medicare change under the health reform law?
- Medicare isn’t part of the Connect for Health Colorado Marketplace established by Affordable Care Act, so you don’t have to replace your Medicare coverage with Marketplace coverage. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now.
- You don’t need to do anything with the Connect for Health Colorado Marketplace during Open Enrollment period.
- You get more preventive services, for less. Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly “wellness” visit.
- You can save money on brand-name drugs. If you’re in the donut hole, you’ll also get a 50% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy—you don’t have to do anything to get it. The donut hole will be closed completely by 2020.
- Your doctor gets more support. With new initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.
