Paying the penalty? Exemptions for the Affordable Care Act

The deadline to sign up for individual health insurance is March 31st, and if you don’t have it by then, the government will impose a penalty fee.

The fee is $95 per adult– or 1% or your annual income– whichever is higher. It will be taken out of your 2014 tax return.

Family First Health in York alone has fielded hundreds of questions about avoiding the penalty. Some low-income clients have been disappointed to find out they can’t afford coverage under the Affordable Care Act.”It’s terrifying because I know that I have health problems and I can’t afford to go take care of them,” says Holly Weir, a Spring Grove, York County resident. “I’m going to be financially penalized if I don’t sign up, but yet I can’t afford to sign up.”
She lost her job at a grocery store last year, so she’s now collecting unemployment benefits. Pennsylvania did not renew its Medicaid program, so that puts her into a coverage gap.
“A lot of people have said, ‘Well, I will take the penalty,'” says patient navigator Arlene Feliciano. “But they don’t realize that it’s going to go up.”
There are several hardship exemptions you can claim. Weir qualifies for the lower-income, “unaffordable” exemption. Some apply to victims of domestic violence, or those who paid to care for an elderly or sick relative. A full list can be found here.
But the details of the exemptions aren’t clear, even to the patient navigators.
“Unaffordability, when their income does not allow them to afford healthcare insurance through the marketplace,” says Feliciano says of Weir’s eligible exemption. Of other exemptions, she says, “We don’t know much about it how they’re going to determine the hardship, and how much money you’ve spent or if you can afford it or not we are not sure how that’s going to, how they’re going to determine that yet.”
Weir chose not to file for the exemption. She’s felt the sting of going without healthcare– after a recent ER visit cost her $10,000 for one night. She hopes for help from family to pay the insurance premiums.
“I need healthcare coverage, I need to be protected, I’m getting older things are going to fall apart,” says Weir. “And I need the healthcare and the system as its set up now, doesn’t help me, I fall between the cracks.”