Understanding the Individual Mandate for Health Insurance Kentucky

According to census data, the number of uninsured Kentucky residents in 2010 was 640,000 or about 14.9% of the state’s population. If you are among the uninsured, it’s time to start thinking about purchasing a health insurance Kentucky policy as the individual mandate of Patient Protection and Affordable Care Act (PPACA) requires that all Americans have minimum essential coverage, with some exceptions, beginning in 2014. Those who do not have health insurance will have to pay a penalty. To understand the individual mandate, it’s necessary to understand ‘minimum essential coverage’.

What Minimum Essential Coverage Means

You would be considered as having minimum essential Kentucky health insurance if you’re covered under any of the following programs: • Government-sponsored plans such as Medicare, Medicaid, CHIP, TRICARE, the veteran’s health program, and so on
• An employer-based plan
• A grandfathered health plan (that was in existence before the health reform law was passed)
• A plan offered in the individual market within Kentucky and which is at least at the Bronze level (a health plan that covers 60% of the cost and requires the enrollee to pay about 40%)
• Any other coverage as approved by the HHS Secretary

Health insurance coverage consisting of excepted benefits, such as dental-only coverage is not included in minimum essential coverage.

Distinguishing Between Minimum Essential Coverage and Essential Health Benefits

The PPACA requires certain health insurance plans sold after 2014 to include a basic package of ‘essential health benefits’ including hospitalization, outpatient services, mate
ity care, prescription drugs, emergency care, and preventive services among other benefits. Benefits could differ among states.

Minimum essential coverage is coverage that is required to avoid the individual mandate penalty and does not have to include these essential health benefits.

Penalty for Health Insurance Kentucky Noncompliance

If you do not comply with the conditions for the individual mandate, you would have to pay a penalty that is the greater of: • In 2014: $95 per adult and $47.50 per child (up to $285 for a family) or 1.0% of household income over the filing threshold
• In 2015: $325 per adult and $162.50 per child (up to $975 for a family) or 2.0% of household income over the filing threshold
• In 2016 and beyond: $695 per adult and $347.50 per child (up to $2,085 for a family) or 2.5% of household income over the filing threshold

Starting 2017, the penalties will be raised by the cost-of-living adjustment.

You would not have to pay the penalty if you’re in any of the following categories: cannot afford coverage as specified under the new mandates; have income below the federal income tax filing threshold; have religious reasons; are an American Indian; have not had health insurance for less than three months; have received a hardship waiver from the Secretary, or are residing outside of the United States, or are bona fide residents of any possession of the United States.

Comprehensive, Affordable Kentucky Health Insurance is Available

Now that you know the pitfalls of not having a health insurance Kentucky plan, don’t lose time. Contact an experienced licensed health insurance broker and benefit from professional guidance to purchase an affordable plan that meets your needs and federal mandates.