Exemptions to the Individual Mandate
There are some cases where there is no penalty to not having coverage.
Eligibility for premium assistance and enrollment in a health plan gets decided every year. They use updated income, family size, and tax information (when authorized).
Before the open enrollment period every year, the Health Insurance Marketplace checks income data. They send a notice you if you enrolled through the Marketplace. This notice explains your eligibility for the upcoming year. It notifies you to let the Marketplace know of any changes.
Insurance companies also must send notices.
They must inform you about the premium cost for the new year.
After this, there is a yearly open enrollment period for consumers to change plans. Or they can change insurance companies if they want to.
For 2015: Consumers enrolled through the Marketplace will be auto-renewed in their current plan. This happens if it is still available. They will have the same subsidies as 2014.
This will not happen to consumers who didn’t give the Marketplace authority to re-check their income.
It will not happen if your income is much higher than was declared in the past. If this happens, you will be auto-renewed without subsidies.
During the year, consumers must report any changes in circumstances. They must report to the Health Insurance Marketplace within 30 days of the change.
Changes include changes in income from a new job.
Consumers who haven’t asked for financial assistance don’t need to report changes related to financial assistance eligibility.
The Marketplace will review available data sources or individuals who become eligible for Medicare, Medicaid, or CHIP.
If you didn’t enroll during the open enrollment period, you may be able to enroll during a special enrollment period (under certain circumstances).
A few examples of special enrollment periods are:
When an individual or dependent loses health insurance coverage
An individual gains a dependent
An individual becomes a dependent through marriage, birth, or adoption
Or an individual moves into a new exchange service area
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