On December 19th, 2013 President Obama announced that:

Anyone who can show that their individual or family policy has been cancelled, will be eligible to buy a “catastrophic” plan through the exchange and qualify for a “hardship exemption”. See list of reasons below.

This means they would not be fined if they can’t, or don’t, enroll in a health insurance plan. These catastrophic plans, however, cannot get a subsidy.

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Possible reasons for exemption to the Tax Penalty

Exemptions From Having To Pay The Tax Penalty

♦ The individual is uninsured less than 3 consecutive months

♦ The lowest priced insurance plan available would cost more than 8.13% of the household income

♦ The individual does not have to file a tax return because income is too low

♦ The individual is a member of federally recognized Indian tribe

♦ The individual is a member of a health care sharing ministry

♦ The individual belongs to a religious sect with objections to receive insurance benefits and Social Security and Medicare

♦ The individual is incarcerated

♦ The individual is not legally present in the USA

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♦ The individual has a hardship determined by the Dept. of HHS for example:

◊ Become homeless

◊ Has been evicted in the past 6 weeks or is facing eviction or foreclosure

◊ Child is denied Medicaid and CHIP and another person is Court ordered to cover that child

◊ Received a shut-off notice from a utility company

◊ Recent death of a close family member

◊ Recent fire, flood, natural or human-caused disaster resulting in substantial damage to individual property

◊ Filed bankruptcy in last 6 months

◊ Recent domestic violence

◊ Substantial medical debt in the last 2 yrs

◊ Unexpected expenses d/t caring for an ill, disabled, or aging family member

◊ Time frame to appeal and overturn a denial of eligibility to get a Marketplace plan

◊ Lost individual plan and believes other coverage options are unaffordable

◊ Other hardships obtaining health insurance

Things Potentially NOT Covered By Your Health Insurance

Things Potentially NOT Covered By Your Health Insurance

To be fair, in recent years, health insurance companies have made strides towards transparency. If you have an ACA-compliant plan, there are many services that your health insurance is legally required to cover, taking some of the guesswork out of budgeting for health expenses.

Medical Loss Ratio

Medical Loss Ratio

This Medical Loss Ratio states that when a family or individual buys a medical plan, 80% of every dollar collected and paid to an insurance company MUST pay medical claims/research. So that leaves the insurance company to pay ALL of their expenses with the remaining 20%. .20 cents on the dollar for their employees, buildings, broker costs, etc.

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