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What If I Have A Pre-Existing Condition?
Regardless of any medical condition a person may have prior to when your coverage starts, insurance companies are required to abide by the rules in respect to the essential health benefits for pre-existing conditions. This means that no insurance provider can reject you, refuse to pay, or let it affect what they charge for medical care. Pricing must also not affect what they charge based on gender. With the exception of grandfathered plans, all insurance companies are required to recognize provide these benefits to pre-exiting condition customers. And of course all Marketplace plans, Medicaid and CHIP provide these essential health benefits as well.
What Is The Penalty If I Do Not Carry Health Insurance?
The fee for no having health coverage is calculated in one of two ways, whichever amount is higher. You may be charged a flat fee or a percentage fee which will be applied to your federal income tax returns for the years that you were not insured.
Below Are The 2021 Fee Calculations:
- Flat Fee – You will be charged $695.00 per adult and $347.50 per dependent (under 18) to reach no more than $2,085.00 per family
- Percentage Fee – In this calculation you will be charged 2.5% of the annual household income above the tax filing threshold, not to exceed the national average for bronze plan premiums.
If You Did Not Have Health Insurance Coverage In 2020, The Fees Were Applied As Such:
- Flat Fee – You will be charged $325.00 per adult and $162.50 per dependent (under 18) to reach no more than $975.00 per family
- Percentage Fee – In this calculation you will be charged 2% of the annual household income above the tax filing threshold, not to exceed the national average for bronze plan premiums.
How Would I Qualify For An Exemption?
If you qualify for an exemption, you will not be subject to the penalty for being uninsured. Below are some examples of exemptions that may apply to you or your family’s situation:
- You were uninsured for under 3 months of the year
- You don’t meet the income tax filing threshold and so are not required to file
- You are not lawfully present in the U.S.
- The lowest-priced plan option provided exceeds 8% of your household income
- You are a member of tribe recognized by the federal government
- You are a member of a federally recognized organization with religious objections to insurance, Medicare, Social Security, etc.
- You are currently incarcerated and serving a term in jail or prison
- You qualify for hardship exemption
You can visit online to see more examples that might qualify you for an exemption from being assessed the fee for non-coverage.
What Is A Life Changing Event, And How Does That Will That Affect How My Health Insurance Works For Me?
A life changing event would generally involve major changes in your life that would directly affect your household income, or the gaining or losing of a family member. These events must be reported, as they could directly affect how your plan is supposed to function and could result in back pay when you file your taxes, if you fail to do so.
What If I Am Pregnant Or Adopt A Child?
Pregnancy and adoption are categorized in the pre-existing condition field and will qualify you for a Special Enrollment Period to enroll or change plans. Once enrolled, coverage will begin as soon as your plan begins.
With adoption, as mentioned above, you may enroll or change plans during open enrollment or a Special Enrollment Period and your new plan will take effect beginning on the date of birth or the start of adoption, not past 60 days of said date.
How Are Grandfathered Plans Affected By Pre-Existing Conditions?
Grandfathered plans that are purchased independently from your employer, are not bound by the pre-existing conditions requirements. But once your grandfathered coverage year ends, you will qualify for a Special Enrollment Period, if necessary, and you can choose to purchase a Marketplace plan that fits the needs of you and your family.