Individual Health Insurance Options in Pembroke Pines, FL

ObamaCare's individual mandate is the unofficial name for the requirement to obtain coverage under the Affordable Care Act and it requires that most Americans obtain health insurance by 2014 or pay a tax penalty. The individual mandate went into effect at the beginning of January 2014 and continues each year. The penalty for not having coverage will be paid on your Federal Income Tax Returns for each full month you or a family member doesn't have health insurance or an exemption and is based on your Modified Adjusted Gross Income (MAGI).

Depending on your coverage, income, and family size, you will either pay a flat dollar amount or a percentage of income above the tax return filing threshold for your 


Depending on your coverage, income, and family size, you will either pay a flat dollar amount or a percentage of income above the tax return filing threshold for your filing status. the fee is capped at the national average for a  Bronze health plan available in the marketplace, and it's only paid for full months you or a family member went without coverage. If you don't obtain and maintain minimum essential coverage throughout the year or obtain an exemption, you'll have to make a Shared Responsibility Payment for each month you went without coverage or have an exemption. If you have coverage for at least one day within the taxable year, then you won't owe the payment for that month.

Individual Reform Mandate Chart Penalty

2015 Tax Penalty Examples - See How it Applies to yor Family

Example 1: A Household of 3 members

If a family of three (two adults, one child) has a household modified adjusted gross income of $105,000, and does not have major medical insurance and does not otherwise qualify for a penalty exemption, the 2015 penalty for this family would be calculated as follows:

1. Figure out the total flat dollar amount:

  • Flat dollar amount per adult = $325 (multiply this by 2 because there are two adults)   
  • Flat dollar amount per child = $162.50
  • Add the flat dollar amount together from the above = $812.50

2. Figure out the 2% of income: 2% multiplied by $105,000 = $2,100

3. Use the greater of the two to find out what your 2015 penalty is: $2100



Example 2: A Household of 6 members

If a family of six (two adults, four children) has a household modified adjusted gross income of $92,000, and does not have major medical insurance and does not otherwise qualify for a penalty exemption, the 2015 penalty for this family would be calculated as follows:

1. Figure out the total flat dollar amount:

  • Flat dollar amount per adult = $325 (multiply this by 2 because there are two adults)
  • Flat dollar amount per child = $162.50 (multiply this by 4 because there are four children)
  • Add the flat dollar amount together from above = $650
  • Also, the maximum flat dollar amount for a family is capped at $975, so that is the amount you use to compare

2. Figure out the 2% of income: 2% multiplied by $92,000 = $1,840

3. Use the greater of the two to find out what your 2015 penalty is: $1,840


Income Levels and Tax Penalties

What is Minimum Essential Coverage

In order to avoid the mandate, you'll have to obtain "minimum essential coverage". Basically, this includes all Government and job based insurance as well as most private insurance. As a rule of thumb, if you have insurance already you don't have to worry about the mandate.



Minimum Essential Coverage Includes the Following:

  • Employer-Sponsored coverage (including COBRA coverage and retiree coverage
  • Coverage purchased in the insurance market including a qualified health plan offered by the Health Insurance Marketplace (also known as the Affordable Insurance Exchange)  
  • Medicare Part A coverage and Medicare Advantage plans
  • Most Medicaid coverage
  • Children’s Health Insurance Program (CHIP) coverage
  • Certain types of veterans health coverage administered by the Veterans Administration
  • TRICARE
  • Coverage provided to Peace Corps volunteers
  • Coverage under the Non-appropriated Fund Health Benefit Program
  • Refugee Medical Assistance supported by the Administration for Children and Families
  • Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014. For later plan or policy years, sponsors of these programs may apply with Health and Human Services (HHS) to be recognized as minimum essential coverage.
  • State high-risk pools for plan or policy years that begin on or before Dec. 31, 2014.  For later plan or policy years, sponsors of these program may apply with Health and Human Services (HHS) to be recognized as minimum essential coverage.



What Doesn't Count as Minimum Essential Coverage

Minimum essential coverage does not include coverage providing only limited benefits, such as coverage for only vision or dental care, or Medicaid that covers only certain benefits (e.g. family planning, workers’ compensation, or disability policies).

Most insurance types offered between each years open enrollment will be short term health insurance, fixed benefit plans and supplemental insurance. They will not help you avoid the fee on their own, but they will help you be covered health-wise.

Not sure if your plan will help you avoid the fee?  Ask your insurer whether or not your plan is “ACA compliant” or counts as “minimum essential coverage.

What Are ObamaCare Subsidies

ObamaCare subsidies can save you money on your premium and out-of-pocket expenses. Cost assistance subsidies are only available through your state’s health insurance marketplace and are only available during open enrollment (unless you qualify for a special enrollment period) The exception is Medicaid and CHIP, which can be obtained at any time of year.

There are three types of cost assistance: Premium Tax Credits to lower your premiums, Cost Sharing Reduction subsidies for lower out-of-pocket costs, and Medicaid and CHIP.

How Subsidies Work

Premium Tax Credit

ObamaCare’s Premium Tax Credits can be paid to your insurer in advance to lower your monthly premium on a Marketplace plan or adjusted on your tax returns. Tax Credits are based on income and available to folks making between 100% and 400% of the Federal Poverty Level FPL (between $11,670-$46,680 for an individual and between $23,850-$95,400 for a family of 4 in 2015).Type your paragraph here.

Tax credits are based on income and cap your monthly premium between 2% and 9.5% of your total house hold Modified Adjusted Gross Income (MAGI) per household member. Caps are based on the second lowest cost Silver plan. The less income you have the lower the percentage of your income you will pay. If your income changes slightly, then the exact amount of assistance you get will too. Each level of the Federal poverty line between 133%-300% equals a different Tax Credit amount, and it’s up to you to decide what percentage of that Tax Credit you want to be paid to your insurer in Advance.

A tax credit can be paid in advanced to your insurer through the Marketplace. This is called an Advanced Premium Tax Credit. The amount paid to the insurer is the difference between your premium cap and the cost of the plan. You’ll see that number reflected when you compare marketplace plans.

Be aware that you should report your income if it changes, or if you have another life change that could affect what premiums you get. If you report life changes the marketplace can adjust your tax credit for you, if not you may end up owing money or being owed money on your tax returns.

Tax credits can be paid in advance to lower your premium upfront or can be deducted from your Federal income taxes at the end of the year. If you didn’t take the full Tax Credit in advance, or you made less than you projected in 2014 and didn’t adjust your info in the marketplace, you can deduct the remaining amount on your Federal Income Taxes using Form 8962, Premium Tax Credit (PTC).

To learn if you qualify for lower costs on health insurance coverage, find your estimated 2015 household income and household size on the chart below. The column on the left tells you if you may qualify for premium tax credits, lower out-of-pocket costs, or low-cost health care through Medicaid.

Eligibility for Tax Credits

You are eligible for a Tax Credit if:

  • You shop through the Health insurance Marketplace
  • Your income is between 100%-400% FPL
  • You are not eligible for other coverage like employer based coverage (this is true even if you are a dependent and a family member offered coverage through another members plan)
  • You are filing a joint return if married
  • Cannot be claimed as a dependent by another person

Cost Sharing Reduction Subsidies

ObamaCare’s Cost Sharing Reduction Subsidies (CSR) lower out-of-pocket costs, based on income, for Silver plans bought on the Health Insurance Marketplace. Along with Premium Tax Credits, ObamaCare’s Cost Sharing Reduction subsidies lower what you pay for health insurance costs.



CSR subsidies only apply to “covered costs” (in-network services covered on your plan). Covered costs usually include only items from ten categories of essential Health Benefits. When you compare plans you’ll see what services are covered in-network and will see the plans out-of-pocket costs reflecting your Cost Reduction Subsidies. Your insurer will only offer to cover part of your costs or count your costs toward your deductible if you use covered in-network services. If you shop out-of-network expect higher costs.

To qualify for Cost Sharing Reduction Subsidies you must:

Shop on the Health Insurance Marketplace (or your state’s Marketplace)
Make between 100% – 250% FPL
Obtain a Silver plan (CSR subsidies are only offered on Silver plans

The amount of out-of-pocket assistance you are eligible for is based on income and is offered to those making between 100% to 250% of the Federal Poverty Level (FPL). CSR subsidies do not lower your premium like Advanced Premium Tax Credits, as they apply only to cost sharing amounts. CSR subsidies reduce your out-of-pocket expenses by raising the actuarial value of your plan (the average out-of-pocket costs an insurer pays on a plan). Specifically, they raise coinsurance, and lower copays, deductibles, and maximum out-of-pocket costs you will pay in a policy period. This means that some folks will not only qualify for lower premiums on a Silver plan via tax credits, but may also get the out-of-pocket costs similar to a Gold or Platinum plan.

Cost Sharing Reduction Subsidies

Income Level Actuarial Value (the amount of costs a Silver plan will cover due to cost sharing reduction subsidies for % of the Poverty Level).


100-150% FPL = 94% Actuarial Value (CSR 94)

150-200% FPL = 87% Actuarial Value (CSR 87)

200-250% FPL = 73% Actuarial Value (CSR 73)

More than 250% FPL = 70% Actuarial Value


Out-of-pocket maximum limits (equal to deductible limits):

100-200 percent of FPL,

your out-of-pocket limit won’t be more than $2,250 for an individual.
your out-of-pocket limit won’t be more than $4,500 for a family.


200-250 percent of FPL,

your out-of-pocket limit won’t be more than $5,200 for an individual.
your out-of-pocket limit won’t be more than $10,400 for a family.


More than 250% percent of FPL,

your out-of-pocket limit won’t be more than $6,600 for an individual.
your out-of-pocket limit won’t be more than $13,200 for a family.

Cost Sharing Reduction - TABLE

Medicaid - CHIP

You can sign up for Medicaid and CHIP 365 days a year. You may qualify for free or low-cost care through Medicaid based on income and family size ($16,105 individual $32,913 for a family of four in 2015). If you think you are eligible for Medicaid, you can sign up for Medicaid now (you can even get coverage retroactively if you qualified but didn’t enroll).

If your state did not expand Medicaid and you have been denied Medicaid coverage, you are exempt from the mandate to obtain insurance and won’t owe the fee. If you apply for a hardship exemption at HealthCare.Gov, you will qualify to shop for catastrophic coverage. The law previously required states to expand coverage to everyone making less than 138% of the Federal Poverty Level (FPL) or lose federal funding to Medicaid. However, that provision was changed during a supreme court ruling on ObamaCare.

States can now opt-out of Medicaid Expansion, leaving millions of poor working families in the “Medicaid coverage gap” between those who qualify for Medicaid (as low as 50% FPL in some states) and those who qualify for marketplace subsides (between 100% – 400% FPL). States opting out of the expansion of Medicaid under ObamaCare is projected both to drive up insurance costs and to save the States relatively small amounts (with some, like Minnesota, showing up to a billion in new revenue under the program).

States expanding Medicaid – AZ, AR, CA, CO, DE, DC, HI, IL, IA, IN, KY, MD, MA, MN, MA, NH, NV, NJ, UT, NM, NY, ND, OH, OR, PA, RI, VT, WA, WV.

States not expanding Medicaid at this time – AL, FL, GA, ID, KS, LA, ME, MS, NE, NC, OK, SC, SD, TX, WI. States considering expanding Medicaid – AK, MO, MT, UT, TN, WY, VA

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