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发帖数: 1430 | 10 http://www.massresources.org/health-reform.html#howmuchpenalty
What is the Massachusetts Health Reform Act?
The Massachusetts Health Reform Act is a state law passed in 2006 that
requires all adult Massachusetts residents to have health insurance if they
can afford it. Residents without health insurance face a tax penalty.
Massachusetts residents with limited incomes may be eligible for MassHealth
or Commonwealth Care. For other residents, the state determines how much you
should be able to spend on health insurance each year, based on your income
and family size.
Note: When the Affordable Care Act takes effect in 2014, Massachusetts
residents will face a federal health insurance requirement as well as the
state requirement. To learn about how this change might affect you, see
Massachusetts Health Care 2014.
Do I have to buy health insurance?
The Massachusetts Health Care Reform Law requires all adult residents age 18
and older to have health insurance. To meet the state's requirements, the
insurance must include certain basic benefits known as Minimum Creditable
Coverage (MCC). For details, see Minimum Creditable Coverage and MCC
Requirements on the Commonwealth Connector web site.
You meet the insurance requirements if you have any of the following health
care coverages:
MassHealth (any coverage type except Limited)
Commonwealth Care or Commonwealth Choice (any plan)
Medicare
Student Health Insurance Plan (SHIP)
TRICARE or Veterans Administration Health Program
qualified high deductible health plan (HDHP)
tribal or Indian Health Service plan
VISTA, AmeriCorps, National Civilian Community Corps, or Peace Corps
coverage
any individual or group health plan that meets MCC requirements
Most residents without MCC health insurance must pay a penalty. However,
people who cannot afford a health plan, or who qualify for an income
exemption, religious exemption, or hardship waiver, do not have to pay a
penalty.
Can I get an exemption or waiver?
Massachusetts residents who can afford MCC health insurance but do not buy
it must pay a tax penalty unless they qualify for an exemption or a waiver.
If your income is at or below 150% of the Federal Poverty Guidelines,
you do not have to pay a penalty.
If you cannot find an affordable health plan, you do not have to pay a
penalty. The Commonwealth Connector has an online affordability tool to let
you see how much you should be able to pay for a health insurance plan
based on your income and family size, and if an affordable plan is available
for you: Commonwealth Connector Affordability
You can claim a religious exemption if you have sincerely held religious
beliefs that prevent you from buying or having health insurance.
If you had a financial hardship during the year and filed for a
Certificate of Exemption before December 1, you do not have to pay a penalty
if you received an exemption. For more information, see Waivers from the
Tax Penalties and Filing a Certificate of Exemption on the Commonwealth
Connector web site.
If you owe a penalty, but you faced a hardship during the year that
prevented you from buying health insurance despite your income, you can file
an appeal when you file your state income taxes. If you have another good
reason for not buying health insurance, you can also file an appeal.
Instructions for filing an appeal are given in the 2012 Schedule HC and
the 2012 Schedule HC Instructions. The Connector Authority makes the
decisions about appeals.
How much is the penalty for no insurance?
Residents without MCC health insurance face monthly penalties. The penalties
add up each month without health insurance, and must be paid at tax filing
time. Short gaps in coverage (up to three months) are allowed without a tax
penalty.
Penalties vary by income and age:
if you are an adult with income above 300% of the Federal Poverty
Guidelines, penalties are based on ½ the cost of the lowest-priced
Commonwealth Choice plan available to you
if you are an adult with income at or below 300% of the FPG, penalties
are based on ½ the cost of the lowest-priced Commonwealth Care plan
available to you
if you are an adult with income at or below 150% of the FPG, you do not
have to pay a penalty if uninsured
The 2013 tax year penalties are:
Income and Age 150.1-200% FPG 200.1-250% FPG 250.1-300% FPG
Above 300% FPG
Age 18-26 Above 300% FPG
Age 27+
Tax penalty $20 per month
$240 per year $39 per month
$468 per year $59 per month
$708 per year $84 per month
$1008 per year $106 per month
$1272 per year
(See What are the penalties? from the Health Connector and Individual
Mandate Penalties for Tax Year 2013 from the DOR.)
You can use the FPG income and household size categories below to see which
penalty category would apply to you.
(For example, if your income is greater than the 150% FPG income amount and
less than or equal to the 200% FPG income amount shown below for your
household size, your tax penalty category would be "150.1-200% FPG.")
Health Insurance Tax Penalty Income Categories - Tax Year 2013
(based on Federal Poverty Guidelines effective January 2013) Household size
Annual Income (% of Federal Poverty Guidelines)
150% FPG 200% FPG 250% FPG 300% FPG
1 $17,244 $22,980 $28,728 $34,476
2 $23,268 $31,020 $38,784 $46,536
3 $29,304 $39,060 $48,828 $58,596
4 $35,328 $47,100 $58,884 $70,656
5 $41,364 $55,140 $68,928 $82,716
6 $47,388 $63,180 $78,984 $94,776
7 $53,424 $71,220 $89,028 $106,836
8 $59,448 $79,260 $99,084 $118,896
each extra person +$6,036 +$8,040 +$10,056 +$12,060
(See 2013 MassHealth Income Standards and Federal Poverty Guidelines)
If you owe a penalty, you will calculate the amount when you complete
Schedule HC of your state income tax return.
To estimate your penalty, see Estimate Your 2012 Tax Penalty on the
Commonwealth Connector web site.
People who cannot find affordable health insurance or who qualify for a
religious or hardship exemption or waiver do not have to pay a penalty. See
Do I have to buy health insurance? for more information.
How do I avoid a penalty?
You must file Schedule HC, Health Care Information, when you file your state
income taxes to avoid the penalty. Residents with MCC health insurance use
Schedule HC to show that they have coverage. Residents without health
insurance can use Schedule HC to request an income, affordability, religious
, or hardship exemption, or to file an appeal.
For information about Schedule HC, or to download a copy of Schedule HC or
the Schedule HC Instructions, see:
Schedule HC and Form 1099-HC
The Department of Revenue also has information about Schedule HC and tax
form requirements, including Health Care Reform Information for Individuals,
to help you understand and fill out your tax return.
Do employers have to offer health insurance?
The Massachusetts Health Care Reform Law required employers with 11 or more
full-time employees to offer a group health plan to their employees (and pay
a fair share of the monthly premiums), or else pay an Employer Fair Share
Contribution. The Employer Fair Share Contribution was $295 per employee
paid into the Health Safety Net Trust Fund.
The Employer Fair Share Contribution was repealed in the Massachusetts
FY2014 budget, effective July 1, 2013.
Note: The Massachusetts FY2014 budget eliminated the state Employer Fair
Share Contribution to avoid overlap with federal ACA employer penalties that
were scheduled to go into effect in January 2014. This would have left only
a six month gap between the elimination of the state mandate and the
beginning of federal mandates. However, federal penalties for employers who
do not comply with Affordable Care Act rules have been delayed, and will not
take effect until 2015.
In addition, all employers with 11 or more full-time-equivalent employees
must set up a Section 125 plan. A Section 125 plan allows employees to buy
health insurance with pre-tax dollars through payroll deduction. This saves
employees money, because the cost of monthly premiums is subtracted from
taxable income, and employees owe less in federal and state income taxes.
Employers who do not obey this law can be charged a Free Rider Surcharge if
their employees do not buy health insurance and use the Health Safety Net (
Free Care) instead.
For more information about employer requirements, see Employers Health
Insurance: Get the Right Plan and Employer Obligations from the
HealthConnector.
How does federal health reform affect Massachusetts?
On June 28, 2012, the Supreme Court upheld the constitutionality of the
Affordable Care Act, the federal health reform law passed in 2010. When the
Affordable Care Act (ACA) takes effect in 2014, Massachusetts residents will
face federal health insurance requirements as well as state requirements.
As a result of the Affordable Care Act:
a MassHealth expansion will allow new categories of residents to qualify
for MassHealth Standard benefits or new MassHealth CarePlus coverage
legally present low-income noncitizens who do not qualify for MassHealth
coverage will be eligible for federally funded health insurance subsidies
the federal government will give health insurance tax credits and
subsidies to low and moderate-income residents (up to 400% FPG) to help
lower their health insurance costs
seniors with Medicare Part D prescription drug plans will pay less for
prescription drugs during the coverage gap known as the donut hole, and the
coverage gap will eventually be eliminated by 2020. (See Medicare Drug
Discounts: What This Means For You from HealthCare.gov for details.)
residents without health insurance may face federal penalties and state
penalties
Note To learn about how the Affordable Care Act changes might affect you,
see Massachusetts Health Care Programs 2014.
Federal health reform also offers these consumer protections:
new insurance policies must offer free preventive services and
immunizations, without copays or deductibles
policies cannot include lifetime limits or unreasonable annual limits on
benefits
insurance companies cannot drop coverage because of claims
children and adultss with pre-existing conditions cannot be denied
coverage
children can stay on their parents' health plans until they turn 26
For more details, see How the Health Care Law Is Making a Difference for the
People of Massachusetts from the U.S. Department of Health and Human
Services.
Useful links
These links are external links to web sites that are not part of
MassResources.org. When you click on these links, you will leave our site.
Click "Back" on your browser to return.
Connect to Good Health, Massachusetts!
Official Connector web site where you can check rates, compare benefits,
and enroll in Commonwealth Choice health care plans. Includes Frequently
Asked Questions. From the Commonwealth Connector Authority.
Commonwealth Choice
Official Commonwealth Choice web site, including overview, benefits,
plan comparisons, and fact sheets. From the Commonwealth Connector Authority.
Health Care Reform Rules and Regulations
The mandated Health Care Reform law Chapter 58 of the Acts of 2006;
Health Connector regulations; and administrative bulletins.
MA Health Care Reform Law of 2006
Detailed information about the health reform law, including history,
facts, progress, legislative priorities, and ACT!! Coalition priorities and
actions.
Employer Health Insurance: Get the Right Plan for Your Business
Information for employers about the Health Reform Act, from the
Commonwealth Health Connector. Includes information about fair share
contributions, Section 125 plans, the Free Rider Surcharge, the Insurance
Partnership, updates, and FAQs.
Department of Revenue Health Care Reform Information for Individuals
Updated information about Massachusetts health insurance requirements,
from the Massachusetts Department of Revenue. Includes:
General Information for Individuals
Schedule HC 2012
Schedule HC 2012 Instructions
Frequently Asked Questions
Health Care Reform Regulations and Technical Information Releases
HealthCare.gov
Information about federal health reform and current health care options,
including answers to frequently asked questions, state-by-state information
, news, forums, and videos. From the U.S. Department of Health and Human
Services.
Health Plans for Individuals and Small Groups in Massachusetts
Consumer information guide explaining individual and small group health
insurance plans, including eligibility, benefits, how to enroll, and answers
to other questions. Developed as a public-private collaboration between
Health Law Advocates, the DPH, MA Attorney General's Office, MA Division of
Insurance, and others.
Health Care Reform - AARP
Detailed information about Health Care Reform, with an emphasis on how
the law affects seniors. Includes the interactive AARP Health Law Guide for
a personalized report.
Schedule HC and Form 1099-HC information
For information about Schedule HC Massachusetts health care information
reporting requirements, follow the link below:
Schedule HC / 1099-HC
Schedule HC is the Health Care Information section of the Massachusetts
personal income tax return. Information that you report on Schedule HC lets
the state know if you have met the minimum basic health care insurance
requirements of the Massachusetts Health Care Reform Law. Form 1099-HC from
your health insurance company lets you know if you have a health plan that
meets the requirements. |
