Penalties: They might apply for those lacking health coverage
FARGO — Those without health coverage should bear in mind the consequences of the personal health insurance mandate as enrollment winds to a close March 31: financial penalties apply.
Provisions of the Affordable Care Act include the requirement that people who aren’t covered by their employers or some other plan, including veterans’ coverage, must obtain health insurance.
The penalty this year for individuals is $95 or 1 percent of annual income, whichever is higher. The penalty for families is $95 per person — $47.50 per child younger than 18 — with a maximum fine of $285.
The penalties increase sharply in the next few years: $325 per person or 2 percent of income in 2015, whichever is higher; $695 per person or 2.5 percent of income, whichever is greater.
The vast majority of North Dakotans — 83 percent, federal figures show — are eligible for subsidized health insurance, either through tax credits that lower the cost of premiums or through expanded eligibility for Medicaid.
For those without coverage who fail to enroll by the March 31 deadline, the real message is that they will continue to be without health insurance, and therefore access to care, said Mike Fierberg, a regional spokesman for the Centers for Medicare and Medicaid Services.
“If you go that route, you still don’t have insurance,” Fierberg said of those opting to pay the penalty. Federal officials are stressing the importance of getting coverage instead of paying the penalties, he said.
“That’s what this marketplace is all about,” expanding access to health insurance, Fierberg said.
The Internal Revenue Service enforces the penalty, which is collected through the federal income tax.
Health insurers have expressed concerns that the penalties might not be enough to prod younger, healthier people to enroll.
The “young and healthy” age segment is crucial to offset the “older and sicker” people who are the most likely to enroll. Too many “older and sicker” enrollees will drive up premium costs.
Ruth Krystopolski, president of the Sanford Health Plan, said the government could have done more to promote health insurance available through the online exchanges.
Still, enrollment to date is running at about the level she expected. As of Feb. 28, 1,009 had enrolled in South Dakota and 181 in North Dakota, she said.
The huge disparity is likely because North Dakota expanded Medicaid access, while South Dakota did not. Also, Krystopolski said, the rate of the uninsured in North Dakota is 10 percent, compared with 14 percent in South Dakota, according to figures from the Kaiser Family Foundation.
“It’s not the marketing,” she said. “It’s the environment of the two states.”
The average age of enrollees in the Sanford Health Plan through the online marketplace is 41 1/2 years, a little older than average for individual coverage, Krystopolski said.
“I think it’s going to be a multiyear process,” she added, referring to increasing enrollment, especially of those who are young and healthy.
As of Feb. 28, Blue Cross Blue Shield enrolled 2,872 people through the online exchange.
“We’re not surprised by any of the numbers we’ve seen so far,” said Luther Stueland, director of health policy impact for Blue Cross Blue Shield of North Dakota.
For Blue Cross Blue Shield, he said, the real gauge of enrollment won’t come until after May 1, when “nongrandfathered” plans are canceled, allowing those people to enroll even though open enrollment ends March 31.
Others who can enroll after that deadline include those whose “life events” — a birth or death in the family, a divorce or marriage — allow an extension.
Otherwise, people won’t be able to obtain health insurance through the exchanges until enrollment opens again Nov. 15 for coverage beginning Jan. 1, 2015.
Federal officials worry that many people are putting off enrolling until the March 31 deadline. If that’s true, people might encounter delays in getting toll-free assistance by telephone or enrolling online, Fierberg said.
“That’s frustrating,” he added. “Nobody wants to go through that.”