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Information for consumers

What does health reform mean for you? Read on to find out.

Individual mandate

Do I need to buy health insurance?
Most people are required to have health insurance, have a coverage exemption, or pay a penalty if they do not. Coverage may include employer-provided insurance (including retiree plans and COBRA coverage), coverage someone buys on their own, most TRICARE plans, Medicare Part A or Part C, or Medicaid.

What is the penalty for not having health insurance?

  • The penalty for not having minimum essential coverage is either a flat amount or a percentage of household income, whichever is greater.
  • In 2016, the penalty is the greater of:
    • $695 for each adult and $347.50 for each child, up to $2,085 per family; or
    • 2.5 percent of family income above the yearly tax filing threshold ($10,150 for individuals; $20,300 for couples filing jointly), up to a maximum penalty of ~$9,792 per family and ~$1,242.50 per person.

NOTE: If you would have otherwise qualified for coverage under Medicaid expansion (see below), but live in a state that has opted out of expanding, you are exempt from the individual mandate penalty.

» Have more questions about the individual mandate? Visit the Kaiser Family Foundation website for FAQs.

Health Insurance Marketplace

The Health Insurance Marketplace is a way to find and buy health coverage that fits your budget and meets your needs. You can compare plans based on price, benefits and other features important to you before you make a choice.

With one marketplace application, you can:

  • Compare plans and apply for health insurance
  • Determine if you qualify for subsidies (tax credits)
  • Determine if you qualify for Medicaid or FAMIS

Those who use the Health Insurance Marketplace may be able to get lower costs on their monthly premiums and out-of-pocket costs. Most people who apply will qualify for some kind of savings.

» Visit healthcare.gov to learn how you can apply for coverage.

Important dates

  • Jan. 31, 2016: Open enrollment for 2016 coverage ends
  • Next open enrollment for 2017 coverage: Fall 2016 (date TBD)

» If you didn’t enroll in a 2016 health insurance plan by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Special Enrollment Period.

Where can I get more information on the Health Insurance Marketplace?

  • VCU Health certified application counselors: Trained certified application counselors can help from 8:30 a.m. to 4 p.m. Monday through Friday at (804) 828-0966.
  • CommonHelp.virginia.gov: Take advantage of Virginia’s fast and easy way to apply online for the Health Insurance Marketplace, Medicaid and many Virginia social services assistance programs.
  • Healthcare.gov: Get the latest resources and learn more about the Health Insurance Marketplace.
  • Enroll-Virginia.com: A nonpartisan, community-based effort to educate all Virginians about the new Health Insurance Marketplace. The statewide toll-free number is (888) 392-5132.
  • Health Insurance Marketplace call center: If you have questions, call (800) 318-2596. TTY users should call (855) 889-4325.

Medicaid expansion

Medicaid is the nation’s main public health insurance program for low-income people. Prior to the passage of the Affordable Care Act, Medicaid eligibility was limited to individuals falling into particular categories, such as low-income children, pregnant women, the elderly, individuals with disabilities and parents meeting specific income thresholds.

The text of the Affordable Care Act expands Medicaid eligibility to include all individuals age 65 or younger as well as families with incomes up to 138 percent of the poverty level. The June 2012 Supreme Court ruling on the ACA allowed states to opt out of this expansion, leaving the decision to expand up to elected officials in each state. Currently, only 32 states and the District of Columbia have expanded coverage.

Virginia is not moving forward with Medicaid expansion at this time.

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Virginia Commonwealth University Medical Center Office of Health Innovation One Capitol Square, 23rd floor, Suite 2310 830 East Main Street Richmond, Virginia 23298-0622 Phone: (804) 828-8301 Fax: (804) 828-2118 Email: ohi@vcu.edu Updated: Created by University Relations