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David Fitzsimmons, The Arizona Star

Affordable Care Act Responsibilities for the Individual


As a tax accountant, I have received many questions from clients and friends about the Affordable Care Act (aka Obamacare). It’s not as complicated as people think, but there are many scams and a lot of misinformation. Below is what you must do in order to be in compliance with the ACA for 2014 if you haven’t already.

Pay attention to the details, because enrolling or not depends on your situation.

IF you are on Medicare, Medi-Cal, Veterans Health, or Indian Health Services — do nothing. Your health care will not change, and if anyone is trying to convince you to buy a new plan or give personal information, that person is a scam artist and can be reported to California Attorney General Kamala Harris’s office here. The only exception to that is when you have a Medicare Advantage plan or Medicare Supplemental Insurance in addition to regular Medicare.

IF you get insurance through your group plan at work or your spouse’s group plan at his or her work — do nothing. If anything needs to be done, your employer or spouse’s employer will do it.

IF you make less than 133 percent of the Federal Poverty Level ($15,856 for a single person, $32,499 for a family of four) — then you will qualify for Medi-Cal next year. If you don’t have any kids, this is a new thing starting January 1, 2014. Medi-Cal will be no cost to you at the time of service, but you should sign up to get it as soon as it becomes available. You can do that through mybenefitscalwin.org. Have your tax return and identification handy because you will have to answer a lot of questions about how much money you make and who is in your household, etc.

You might also want to scout out a doctor who takes Medi-Cal patients, which you can do here, and try to make an appointment pretty soon. Although Medi-Cal is expanding in California, there is nothing that compels doctors to take it, so you want to become a patient with a doctor before they limit their number of new Medi-Cal patients. So sign up, find a doctor, make an appointment.

IF you are not on a plan at work and you are not eligible for a government health plan and you have a social security number — then you are supposed to get health insurance for yourself and any uncovered members of your family starting January 1, 2014. This is also new. If you sign up for a plan before December 15, you will be covered by January 1, 2014, but you have until March 31 of next year to sign up for a plan for 2014 without being penalized for the year. You can buy any comprehensive plan that you want. Not buying a plan and paying the penalty at the end of the year is an option, but then you wouldn’t have health-care coverage.

IF you make between 133-400 percent of the federal poverty level ($15,857-$45,960 for individuals, $32,500-$94,200 for a family of four) and you have a social security number — you may qualify for some financial assistance from the federal government for the cost of your health insurance premiums. However, you only get the premium subsidies if you buy a plan from the California health-care exchange, which you will find at CoveredCA.com. Healthcare.gov is for states that chose not to run their own exchange and will not pertain to anyone in California. The website CoveredCA.com works well by all accounts. I’ve been on the website with several clients, and it’s pretty easy. All other websites calling themselves the California health care exchange are scams and can be reported to California Attorney General Kamala Harris’ office at oag.ca.gov/contact/consumer-complaint-against-business-or-company. Have your tax return information ready because you will need information from it. If you really want to deal with a human being, make sure they are a Certified Enrollment Counselor (CEC), who are the only ones trained and qualified to help you. By the way, I am notCEC.

Your Adjusted Gross Income (AGI) is line 37 on the Form 1040 tax return, line 21 on Form 1040A, or line 4 on Form 1040EZ. If you are self-employed and your income varies from year to year, then try to sign up with a reasonable estimate of what you think you will make in 2014. If you really have no way of knowing your income next year, then use 2012 numbers, or 2013 if you get that tax return done in time for when you need coverage. There is more to the Affordable Care Act than what is contained in this article, but these are the basic requirements for individuals in 2014.

Shannon Miller is an Enrolled Agent, or a federally authorized tax practitioner who may represent clients before the IRS; her tax practice in Santa Barbara specializes in individuals, small businesses, and nonprofits. She has gathered the information she shares here, but she claims no responsibility over how this information is used, nor advocates for any particular product or service, nor has she been paid to disseminate this information.

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