HomeCan You Get In Trouble For Not Having Health Insurance

Can You Get In Trouble For Not Having Health Insurance

Can You Get In Trouble For Not Having Prenatal Care

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Its common knowledge that expectant mothers should receive prenatal care during their pregnancy. But, for some women, prenatal care isnt readily accessible. Worried about the effects of insufficient prenatal care on themselves and their babies, they may also worry about other repercussions, asking:

Is it illegal to not get prenatal care?

There are no laws in the United States requiring expectant mothers to obtain prenatal care. Receiving medical care can be a highly personal decision, and the U.S. government treads lightly in forcing individuals to receive or not to receive certain care during their lives. So, legally, you cannot get in trouble for not having prenatal care but that doesnt mean that there arent other repercussions for you and your child should you refrain from receiving medical care.

Access Quality And Equity Implications

The hidden consequences of failure to ensure universal coverage in the US are well documented.5 The Institute of Medicine estimates that 18000 lives are lost annually as a consequence of gaps in coverage. It calculates the annual cost of achieving full coverage at $34bn- $69bn, which is less than the loss in economic productivity from existing coverage . Expanding coverage would disproportionately help people on low incomes, who make up two thirds of the uninsured, thus increasing equity in access to health care and health outcomes.5

In the US market based system, gaps in health cover contribute to underuse of effective services.6 People who are uninsured or underinsured are more than twice as likely to report going without needed care because of costs.7 When they do receive medical care, they often spend a high fraction of income on out of pocket medical expenses and face financial difficulties.7 Uninsured people are often the only ones charged full price for health care they do not benefit from discounts from providers negotiated by managed care plans, further raising access barriers and debt burdens for those who become sick.

Choosing A Health Insurance Plan

Reading the fine print is important when choosing health care plans. These questions may help:

  • Can I go to any doctor, hospital, clinic, or pharmacy I choose?
  • Are specialists, such as eye doctors and dentists covered?
  • Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
  • Does the plan cover home care or nursing home care?
  • Will the plan cover all medications my physician may prescribe?
  • What are the deductibles? This is the amount you must pay each year before your insurance company will begin paying claims.
  • Are there any co-payments? This is the amount of money you pay each time you receive medical services or a prescription.
  • If there is a dispute about a bill or service, how is it handled?

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What Benefits Must Be Covered

The ACA set new minimum standards for all health plans. There are no longer pre-existing condition limitations or questionnaires about your health status to complete. Insurers are required to provide their customers with a summary of their plans coverage, which much include all services listed in the Washington State benchmark plan. To view a summary of the benefits included in the Washington State benchmark plan, click here. In addition to required services, insurers can choose to include additional services in their plans. Your plan must give you a summary of benefits and coverage and a glossary of commonly used terms before you enroll and each year when you renew your plan. State law requires your insurer to give you certain other information if you request it.

Excuses About Not Having Health Insurance That Women Must Stop Making

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Did you know that women live longer on average than men? This doesnt, however, make them invincible and women should still focus on living healthy and getting the right insurance to deal with lifes inevitable health emergencies. But many women simply dont have health insurance and they tend to use four common excuses to justify not getting health insurance.

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Be Smart With Your Money

Whether you have insurance or not, always try to get the cheaper generic versions of prescription medications if you can. You need not worry about their effectiveness the FDA wouldnt let them on the market if they didnt contain the same ingredients and do the same job as their name-brand counterparts.

Furthermore, dont engage in risky behaviors. None of us really needs to be drinking, smoking, or skydiving. The less we put ourselves in abject danger, the less likely medical issues will arise in the first place. Regardless of our ability to pay, we can surely all do with fewer of those.

We say this a lot here at the National Assistance Network, but the best thing you can really do is know your options. Shop around and you might find another option that works best for you that even we dont know about. As always, it never hurts to be vigilant.

Premium Subsidies And Buying Coverage

If you dont have health insurance through your job or a government program, you may buy a plan from an insurance company or agent. You can also buy coverage through the federal health insurance marketplace at HealthCare.gov or by calling 1-800-318-2596. For lists of companies and health maintenance organizations selling individual plans in Texas, visit TDI’s Lists of Companies and HMOs.

  • Open enrollment. You usually must buy health insurance during the annual open enrollment period. The open enrollment period is from November 1 to January 31 each year. You may qualify to buy health insurance at other times of the year if you lose existing coverage, or have life changes like getting married, getting a divorce, or having a baby.
  • Preexisting conditions. Health insurance companies must sell a plan to anyone who applies during the open enrollment period. Companies may not deny you coverage or charge you more because of a preexisting condition or disability.
  • When deciding your premium, insurance companies may consider only your age, where you live, whether you smoke or use tobacco, and whether the coverage you’re buying is for an individual or a family. They may not consider your health status, medical condition or history, claims experience, genetic information, gender, disability, or other health factors.

Premium Subsidies

For more information about subsidies, visit the HealthCare.gov subsidies page.

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If I Don’t Buy An Aca

The Affordable Care Acts individual mandate penalty was reduced to $0 as of 2019, so there is no longer a federal penalty for not having minimum essential health coverage.

But unless you qualify for an exemption, there is a penalty for being without minimum essential coverage if you live in California, Rhode Island, Massachusetts, New Jersey, or the District of Columbia. You dont necessarily need ACA-compliant coverage in order to avoid the penalty in those states, and there are some types of minimum essential coverage that arent ACA-compliant . But an ACA-compliant plan is going to give you the most robust coverage.

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If youve got coverage under a pre-ACA plan , its likely not compliant with the ACA. But it is considered minimum essential coverage so it will fulfill a state-based individual mandate and you wont be subject to a penalty.

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Its in your best interest, however, to make sure you carefully compare it with the ACA-compliant plans that are available for purchase during open enrollment or when your existing plan is up for renewal, or during the COVID-related enrollment period that continues through August 15, 2021 in most states. And even if you looked a few years ago and werent eligible for premium subsidies, you may be subsidy-eligible now.

This is always a possibility due to yearly increases in the poverty level , but the American Rescue Plans substantial enhancement of premium subsidies for 2021 and 2022 means that coverage is much more affordable than it would normally be. And there is no income cap for subsidy eligibility in 2021 and 2022 instead, people who earn more than 400% of the poverty level can still qualify for a subsidy if the benchmark plan would otherwise cost more than 8.5% of their ACA-specific modified adjusted gross income.

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Aca Goal: Insure Most Americans And Keep Them Insured

The overarching goal of the Affordable Care Act was to extend health insurance coverage to as many Americans as possible. In that regard, it’s had significant success. From 2010 through 2016, the number of people with health insurance in the U.S. increased by roughly 20 million. And although the uninsured rate has been increasing since 2017, it has been below 10% since 2015.

But while access to health insurance is important, it’s also important that people maintain their coverage going forward. Keeping as many people as possible in the risk poolespecially when they’re healthy and not in need of immediate carekeeps premiums affordable. And while health insurance coverage is certainly not cheap, it would be far more expensive if people could just wait to purchase coverage until they were in need of medical care.

For Starters Maybe You’ll Get A Bigger Tax Bill Next Year

As most people know, the Affordable Care Act says that all Americans must either have health coverage or pay a penalty for not having health insurance. Heres how thats going to work.

When you file your 2014 taxes, you’ll be asked to check a box saying whether or not you had insurance. This year only, the Internal Revenue Service really won’t have a way of checking if you’re lying about having coverage, but remember your legal obligation to be truthful on your return.

If you didn’t have insurance in 2014, you will either have to provide a valid reason why you didn’t have to be covered or pay a fine.

How big is the fine?

You may have heard that the penalty for not having health insurance is only $95 for the year, but thats only for certain people. Heres the full formula. For the 2014 tax year, youll pay the greater of these two numbers: A. 1 percent of your household income above $10,000, up to a maximum of $2,448 per person or B. $95 per adult and $47.50 per child, up to a family maximum of $285.

In 2015 the penalty gets bigger. Its going to be 2 percent of your household income or $325 per adult and $162.50 per child up to a family maximum of $975.

To spare you the trouble of doing the math, the Tax Policy Center has a calculator that will figure your penalty for you. For instance, a family of four with an income of $60,000 would pay a penalty of $285 in 2014 and $650 in 2015.

What if I had insurance for part of the year?

How will the government collect it?

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Exemptions For Unaffordable Coverage Through Mnsure

You can claim this exemption based on coverage being unaffordable for the months in 2018 when you did not have coverage when you fill out your 2018 tax return, which was due in 2019.

You can claim this exemption using the federal Form 8965. You will need to use the following information from MNsure to complete this form:

  • The premium amount for the lowest cost 2018 bronze plan that would have covered all members of your household seeking an exemption and
  • The premium amount for the second-lowest cost 2018 silver plan that would have covered all members of your household seeking an exemption.

This information is easy to find using the instructions below.

NOTE: If you are applying for an exemption for unaffordable coverage from your employer, you do not need any information from MNsure. You will need to follow the directions on the federal exemption application to submit information about your employer’s plan. You can claim this exemption when you file your taxes using the federal Form 8965.

Can I Get Insured After Losing Coverage Through Employer Family Member Or Medicaid

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If you lose coverage through a spouse or parent, or becomeineligible for Medicaid, you can still get insurance coverage. These coveragelosses are examples of qualifying life events that may give you eligibility ina special enrollment period. A special enrollment period allows you to enrollin major medical health insurance plans outside of the open enrollment period.

If you qualify for a special enrollment period whichtypically last 60 days you will have to prove that you experienced aqualifying life event in order to purchase a health insurance plan off thefederal or state marketplace, or through a licensed broker.

If you lose coverage through an employer or family memberand you believe that you may qualify for federal assistance, you can applyanytime throughout the year for Medicaid and CHIP two government programsseeking to provide low-cost or free health insurance to low-income individualsand families.

Even if you do not think that you will qualify for Medicaidor CHIP based on income alone, it is a good idea to apply anyway, especially ifyou are disabled, have children or are pregnant.

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No Prenatal Care: Consequences And Risks

Theres a reason why prenatal care is so encouraged by medical professionals around the world: It is incredibly important for protecting both expectant mother and child.

Having a baby without prenatal care opens you to all kinds of potential risks and complications. While there is always the chance that you and your baby will be perfectly fine with no prenatal care, there is a greater chance that something can go wrong, an underlying condition can go undetected or another health issue may befall you or your child.

Before you decide to refrain from receiving prenatal care at all, consider these risks of no prenatal care during pregnancy:

  • Pregnancy complications, including conditions such as gestational diabetes, miscarriage, high blood pressure, preeclampsia and more
  • Negative effects on the baby, such as preterm delivery or low birth weight
  • Worsening of chronic conditions, such as diabetes, asthma and heart problems
  • Ante- and post-partum depression and other mental illnesses

Perhaps the most stunning statistic of all? Babies whose mothers received no prenatal care are five times more likely to die than those whose mothers received regular prenatal care.

Clearly, a pregnancy without prenatal care is a dangerous pregnancy, even if you have no known health conditions or pre-determined pregnancy risks. Dont take the risk: Find local prenatal care as early as possible in your pregnancy.

Effects On Insurance Premiums

The elimination of the individual mandate penalty in 2019 contributed to higher individual market premiums for 2019, because insurers expected that the people likely to drop their coverage after the penalty was eliminated would be healthy, whereas sick people will tend to keep their coverage regardless of whether there’s a penalty for being uninsured.

The penalty’s original purpose was to encourage healthy people to join the risk pool, as a balanced risk pool is necessary for any health insurance product to function.

According to rate filings for 2019 plans, average premiums would have for 2019 if the individual mandate penalty had remained in place .

The primary reason average premiums increased instead of decreasing for 2019 was the elimination of the individual mandate penalty, along with the Trump administration’s efforts to expand access to short-term health plans and association health plans.

Those plans appeal to healthier individuals, so their expansion has the same effect as the penalty repeal, in terms of reducing the number of healthy people who maintain ACA-compliant individual market coverage. Note that although average benchmarkpremiums decreased slightly in 2019, overall average premiums did increase that year.

But because the ACA’s premium subsidies adjust to keep coverage affordable even when premiums increase, the majority of people who buy health plans in the exchanges have continued to do so.

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How To Enroll And Get Answers To Your Questions

You can learn more about and apply for ACA health care coverage in several ways.

  • Visit HealthCare.gov to apply for benefits through the ACA Health Insurance Marketplace or you’ll be directed to your state’s health insurance marketplace website. vary by state.

  • Find a local center to apply or ask questions in person.

  • Download an application form to apply by mail

Find the answers to common ACA questions about submitting documents, getting and changing coverage, your total costs for health care, tax options, and more.

Health Insurance Coverage As A Voluntary Benefit

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Many smaller companies offer health insurance as a benefit, even if they aren’t required to by law. In fact, the majority of Americans have health insurance coverage through an employer. A study by the Urban Institute reported that 83.1% of all workers were offered health insurance through an employer in the first quarter of 2016.

In other words, you are likely to receive health insurance through your company, but it’s perfectly legal for employers of any size to refuse to provide it.

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Suggested Government Actions To Achieve Universal Health Cover


  • Legislate to match state funding for cover of adults on incomes up to 1.5 times the federal poverty threshold
  • Allow small businesses and uninsured people to purchase cover through the Federal Employees Health Benefits programme
  • Require all businesses to either provide health benefits to all employees or contribute $1/hour of work towards cover under public programmes and require everyone to purchase cover
  • Extend Medicare programme to uninsured adults aged 55 to 64 and eliminate two year wait before disabled people are eligible
  • Revise Medicare’s payment system to reward higher quality and greater efficiency, with savings used to expand coverage
  • Dedicate tax of 1% of income to financing expanded cover and use existing subsidies for low income charity care to finance expansion


  • Revise the children’s health insurance programme to include adults on incomes up to 1.5 times the federal poverty threshold and children up to 3 times the threshold
  • Revise Medicaid’s payment system to reward higher quality and greater efficiency, with savings used to expand cover

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