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New York State First in Nation to Add Pregnancy as a ‘Qualifying Life Event’ for Obamacare

Insurance coverage takes effect at the start of the month that a woman is certified pregnant. (Image:  Pixabay via CC0 Public Domain)
Insurance coverage takes effect at the start of the month that a woman is certified pregnant. (Image: Pixabay via CC0 Public Domain)

People without health insurance usually only have a three-month window each year to apply through state marketplaces before incurring a hefty fine under the Affordable Care Act, also known as ObamaCare.

However, there are some exceptions. People who are eligible for Medicaid, and people with a “qualifying life event” can obtain insurance through the marketplaces outside of the open enrollment period, which runs October through December.

Qualifying life events include moving to another state, the loss of health insurance, birth or adoption of a child, marriage, divorce, or the death of a spouse. People should apply for health insurance through their state marketplace within 60 days of a qualifying life event.

New York State just became the first in the nation to pass legislation that allows pregnant women to apply for insurance through the marketplace anytime during their pregnancy. Insurance coverage takes effect at the start of the month that a woman is certified pregnant.

Low-income families and individuals can apply for Medicaid through health insurance marketplaces at anytime throughout the year, and this includes pregnant women. Children can also apply for coverage at any time.

Individuals who earn less than $16,243 a year, and a family of four with an annual income less than $33,465 a year would likely be eligible for Medicaid.

The penalty for not having health insurance

Individuals and families who remain uninsured in 2016 could be liable for more than double the penalty of 2015.

The penalty is paid off when you file your taxes. It is calculated per month that you didn’t have insurance, either by household income or per person without insurance in the household — whichever figure is higher.

In 2016, the penalty is 2.5 percent of annual income capped at the average annual cost of a bronze health plan through the marketplace. If the penalty is calculated per person, it will be $695 per uninsured adult and $347.50 per uninsured child under 18, with a maximum liability per family of $2,085.

For 2015, the penalty is 2 percent of household income, which is also capped at the average annual cost of a bronze health plan. Or, if calculated per person, it is $325 per uninsured adult, $162.50 per uninsured child under 18, with a maximum penalty of $975.

People who have suffered the bereavement of a family member, have certain religious beliefs, or have certain forms of financial hardship can apply for an exemption to avoid the penalty.

The penalty for 2016 is the higher of these:

Percentage of income:

  • 2.5 percent of household income
  • Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace

OR:

  • $695 per adult
  • $347.50 per child under 18
  • Maximum: $2,085

The penalty for 2015 is the higher of these:

  • 2 percent of household income:
  • Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace

OR:

  • $325 per adult
  • $162.50 per child under 18
  • Maximum: $975

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