of the least expensive 2018 Affordable Care Act marketplace plan in their local area.Using household income, family size, ages of family members, and zip code data, the tool provides a projection of an individual’s penalty for not being covered, along with information about possible eligibility for financial assistance and premiums for the lowest-cost ACA marketplace plan in their local area. The calculator also helps consumers determine whether they could be eligible for the Medicaid expansion under the ACA.
For example, two 60-year-olds with no children and a household income of $50,000 living in the Arizona zip code 85543 would owe an estimated individual mandate penalty of $1,390 if they go without coverage in 2018. However, they likely qualify for financial assistance that would cover the full cost of a premium for the lowest-cost plan offered by the marketplace in their area.
By contrast, a 40-year-old in the Washington state zip code of 98026 who has an income of $100,000 would owe an estimated individual mandate penalty of $2,234, an amount that is less than the $3,536 yearly premium for the lowest-cost marketplace plan in that area.
The Affordable Care Act’s individual mandate requires that most people have health coverage or be subject to a tax penalty unless they qualify for certain exemptions. The new calculator tests for exemptions related to insurance affordability, tax filing status, and if a state has not expanded Medicaid, but does not test for all exemptions from the individual mandate penalty.
The individual mandate is still in effect, though Congress is may consider repealing it as part of tax legislation.
The Individual Mandate Penalty Calculator is among a stable of resources that KFF has produced to help inform consumers about their options for 2018 health plans in the individual market. For most states, the deadline for open enrollment in ACA marketplaces is Dec. 15, 2017.
The updated Health Insurance Marketplace Calculator helps consumers estimate their health insurance premiums and government subsidies for 2018 ACA marketplace plans.
The updated Health Reform Frequently Asked Questions offers a searchable collection of more than 300 questions and answers, covering a wide range of topics including eligibility for financial assistance, coverage options, plan renewal, and enrollment periods. Some questions are also available in Spanish.
Two short explainers provide the basics of ACA open enrollment for people who are low income and people who buy coverage in the individual market.
Source: KFF
