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Do I Really Have to Sign Up? Last-Minute Obamacare Answers

Image: Alliestean Reese and Cecilia Edwards

Alliestean Reese, left, helps Cecila Edwards sign up for health insurance on March 15 during a Miami Health Fair. J Pat Carter / AP

It’s now down to the final days for people to sign up for health insurance on the new state and federal exchanges. The White House and its allies are making a final push to get people to sign up by March 31. At last count, 5 million people had.

Polls show people still are confused about the law’s requirements. We can clear up some of the confusion:

Do I really have to sign up now?

Only if you don’t already have health insurance, either through an employer or via Medicare and Medicaid. The 2010 Affordable Care Act requires that just about everyone get health insurance or pay a penalty. March 31 is the deadline to sign up for 2014. So-called open enrollment closes after then, and you’ll have to wait until November to try again.

Aren’t there exceptions?

Quite a few. And the federal government added one more this week. If you attest that you started the process but couldn't finish by the deadline, you can have until mid-April to finish. That's for the federally run site covering 36 states -- if you are in a state running its own plan, such as Connecticut, you may not get the break.

There’s the standard exception that’s always been the case with health insurance: If you lose your insurance for any reason, such as changing jobs, or if you get married or have a child, you can change your coverage on any plan, and that includes the insurance exchange plans.

People covered by the government high-risk pools also get a few extra weeks. The Health and Human Services Department says people in the Pre-Existing Condition Insurance Plan (PCIP), a federally run plan for people who couldn’t get insurance because of previous illness, could have another month to sign up.

People who fall into the Medicaid gap also get a break. The ACA originally planned for all 50 states to make Medicaid available to many more people, but the Supreme Court said they didn’t have to. Many states, all controlled by Republicans, decided they wouldn’t do so, even though the federal government would pick up the entire cost for several years. Right now 25 states and Washington, D.C., have expanded Medicaid, but 19 have said they won’t and six haven’t decided.

The law assumed the poorest people will have Medicaid, so they don’t qualify for federal subsidies on the exchanges. For them, health insurance is likely to be too expensive. “So, in the interim, the best we can do for those unfortunate folks who are caught in this situation is to say to them that they will not be subject to a penalty for not getting health insurance. It's not their fault that the state is not doing what it should do,” President Barack Obama told WebMD in an interview earlier this month.

Some of the other hardship exemptions: if you’re homeless, have been evicted recently, have been though a recent natural disaster, had high medical bills you couldn’t pay or had a death in the family.

I have been trying to sign up and can’t.

You’re in good company. If you can document that you have been trying and encountered technical problems on the federal website, you may get an extension. Maryland is also offering extensions to people who have tried but failed to sign up on its badly troubled exchange. Nevada and Oregon are looking into similar exceptions.

I don’t have insurance and don’t want it. Isn’t it better for me to just pay the $95 fine?

Although the $95 fine has been widely publicized — actually, it’s technically a tax — that’s just the minimum penalty. The law says you can be penalized $95 or 1 percent of your salary, whichever is greater. The Tax Policy Center has a calculator that shows for big earners with children who also go without insurance, the penalty could be as high as $11,000.

“The penalty really applies to folks who clearly can afford health insurance but are choosing not to get it and then essentially they are relying on you and me and others who are paying insurance premiums to subsidize them,” Obama says.

How do I get the subsidy?

This gets calculated as part of the enrollment process. It depends on your income, whether you have access to insurance through an employer, and what kind of insurance plan you buy. The Kaiser Family Foundation has a calculator that can give you an idea of whether you qualify. It's roughly based on the federal poverty level of $11,490 for a single person and $23,550 for a family of four.

And you don't get the subsidy in cash — it comes as a tax credit next year.

What about people who don’t have computers?

This is a big challenge for the Obama administration and for states that are trying to promote their own exchanges. Supporters such as Get Covered America are holding “events” in places such as public libraries, recreation centers and at concerts to try to attract people who might not be looking online or who don’t have computers. There are also call centers, and many low-cost medical clinics have staffers with laptops on site almost full-time to try and catch people who need insurance the most and who are the least likely to know about the exchanges.

Both the call centers and the in-person navigators are signing everyone up online, and people must have an e-mail address to enroll, even if that’s the only thing they use e-mail for.

Why not just wait for the Republicans to win in the fall and repeal the law?

Most experts agree it's extremely doubtful that even a Republican-controlled Congress could repeal the law. Current repeal efforts are completely symbolic, since Democrats control the Senate. They'd have to have a veto-proof majority.

One possibility would be a repeal of the individual mandate — this is the provision that says you must have insurance. But insurance companies insisted on this provision as a condition of even taking part in the exchanges, and although Republicans denounce it now, many supported this provision when the law was being written. It's unlikely to go away.