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The countdown continues.  Tomorrow is the last day to buy individual insurance, absent a qualifying event.  After March 31, you may only purchase insurance if you have a qualifying event. This is on and off the Exchange.  I can't tell you how many people tol me this week, "I will call you later, after I do my taxes".  They thought you could buy insurance, just not on the Exchange.  Well, that's not true. You will only be able to buy temporary or short term insurance and it will not be compliant with the law, so you will be subject to the penalty when you file your taxes for 2014. As of this writing there is no extension for off the Exchange.

However, the state of CA Exchange, Covered CA, has indicated that if an individual started an online application by 11:59 p.m on March 31, 2014 will have until 11:59 on April 15 to complete the application and select a plan.  It's critical to understand that what you hear on the news about the Federal Exchange is not necessarily the same in CA.

 

To start an application, individuals must take at least the following steps: 

  • Create an online account.
  • Complete all required information on the "Apply for Benefits" page and click on "Continue."  The page contains two required fields. 
  • After clicking on "Continue," the individual will be taken to the "Consent for Verification" page, where they need to click on "Save & Exit" or "Continue." 
  • Individuals must return to their online account no later than April 15 to complete the application and select a plan.

Note if you want the assistance of an agent, click the "find help near you" icon and request an agent.

Individuals who complete their online applications, and make their premium payment on time, will get coverage beginning May 1.  Paper applications must be completed (including plan selection) and postmarked by March 31, 2014 in order to meet the open enrollment deadline.  Open enrollment for 2015 will begin next fall.

The Covered CA hotline was not taking calls most of the week, it simply referred you to the website and hung up.

Note that MediCal and Federally Recognized Indian tribes are not subject to this deadline.  They have a continual open enrollment period. If you sure you are eligible for MediCal and not any subsidy, you might want to check out the see4yourself.com.  This is a relatively easy portal to start the application and get into the system. Plus we are told that MediCal can then communicate with you via email which will save a lot of time.

So, what is the penalty if you do not have insurance?  This year, it is the greater of

*$95 per adult and $47.50 per child or

*1% of household income that is above the threshold for filing taxes

For example, if you are single with income over $19,650, you will pay the 1%.  If income is below $10,150 you owe nothing; in between those numbers it will be the $95.

You may qualify for an exemption if you meet one of several criteria, such as
       *uninsured for less than 3 months of the year

       *lowest priced coverage available to you would cost more than 8% of your income

       * member of a federally recognized tribe

       *Religious exemptions or a member of a recognized heath care sharing ministry

       *incarcerated

        *not legally present in the US.

There are also hardship exemptions that may qualify that must be requested when you file your 2014 return or via the exemption application found on the healthcare.gov website.

Of course, all of this may avoid the penalty, but it does nothing to provide health insurance for you or your family. With the addition of the subsidies, many people will find that they really can afford coverage and not have to face bankruptcy in the event of a serious illness.

If you looking at your options and you don't qualify for much of a credit or you are not in the "sweet spot' that gives you enhanced benefits as well as subsidy, I encourage you to consider how much risk you want to take.  When you consider that the bronze, silver and gold plans have the same maximum out of pocket limit of $6350, you really must consider if it is worth paying more for the higher level plans.  I usually recommend that folks take the highest deductible they can afford. There is no reason to trade dollars with the insurance company. 

Through February Covered CA reports that 33,111 enrollments were processed for our northern counties.  This represents 3.7% of the 888,082 enrolled.   Over 90% of these were eligible for a subsidy. This does not count those that enrolled directly through insurance companies.

*Information provided in this column is "to the best of my knowledge based on press deadline. Submit your questions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to be answered in the paper.