Getting Health Insurance by 2014

*** PLEASE READ: If you have health insurance on April 1, 2014 and keep insured for the remainder of the year (April 1 – December 31, 2014), you will not have to pay a fine. You have until March 15, 2014 to enroll in health insurance through your state’s health insurance marketplace for coverage to begin April 1, 2014. ***

The individual health insurance requirement is a complex thing to understand, so the best way to prepare for the upcoming changes is to get familiar with them today! Below are three things to know about the requirement and how artists’ access to health insurance has expanded in 2014.* Click on the questions (with arrows) to learn more! This page was last updated on 2/11/14.

*Springboard for the Arts is not a provider, agent, advisor or consultant of healthcare or health insurance. By using this service, you understand and agree that the information contained herein is not intended nor implied to be, and you will not use it as, a substitute for professional legal, tax, insurance or healthcare advice. This webpage is an online information service provided solely as a non-partisan source of information. The information contained herein has been compiled thanks to Kaiser Family Foundation, healthcare.gov, the Journal of the American Medical Association, Families USA, The Advisory Board Company, The Artists Health Insurance Resource Center, The New York Times and the state of Minnesota.

1. There’s a new legal requirement to have health insurance. Starting January 1, 2014, Americans must have health insurance or pay an annual fine.

Who must have health insurance?
All Americans will have to have health insurance or pay an annual fine, but there are some exempt from the requirement. You will not have to pay if you:

  • Have a family income below the threshold requiring you to file a tax return (for the 2012 tax year, this is $9,750 for an individual and $19,500 for a family. Note: this limit is slightly higher for those aged 65+).
  • Would have to pay more than 8% of your family income for “adequate” health insurance, after taking into account any employer contributions or tax credits offered. Continue reading to learn more about what defines “adequate” health insurance.
  • Are part of a religion that opposes the acceptance of benefits from a health insurance policy.
  • Are an undocumented immigrant.
  • Are incarcerated.
  • Are a member of an Indian Tribe.

Check out this infographic from Kaiser Health Reform about who’s exempt from the law.

What health insurance must I have?
The government is using a new rating system to determine if your private health insurance plan provides “adequate” coverage to meet the requirement. Plans are rated Platinum, Gold, Silver or Bronze:

Level of coverage Plans typically pay this % of your covered healthcare costs*
Platinum 90%
Gold 80%
Silver 70%
Bronze 60%


To have “adequate” health insurance coverage, you must either:

  • Be enrolled in a public healthcare program (like Medicaid or Children’s Health Insurance Program)
  • Have a Platinum, Gold, Silver or Bronze-level private health insurance plan (if you are 30 years of age or older)
  • Have a catastrophic (high-deductible) private health insurance plan (if you are a young adult under 30 years old). In other words, young adults under 30 years old are allowed to satisfy the health insurance requirement with a plan rated lower than Platinum, Gold, Silver or Bronze.

Starting in 2014, all insurance plans sold to individuals and small employers will be required to offer coverage for ten types of healthcare services; how much coverage will depend on your healthcare plan. For a full list of these required services, called “essential health benefits,” please click here. While you’re not required to have insurance coverage beyond these essential health benefits, your insurance plan may still cover other services (for example, public healthcare programs may include dental care for adults).

*The government rates plans Platinum, Gold, Silver or Bronze based on something called an “actuarial value.” This actuarial value is a combination of your deductible, co-payments, and co-insurance. So, a Silver plan with an actuarial value of 70% predicts that you’d pay 30% of your healthcare costs through a combination of your deductible, copays and coinsurance, and the insurance company is predicted to pay the remaining 70%. For more information on actuarial values, please click here.

What's the annual fine for not having health insurance?
If you don’t document on your 2014 tax return that you had “adequate” health insurance for you and your dependents (if applicable), you’ll pay a fine back to the government. The annual fine starts at $95 per adult and $47.50 per child (up to $285 for a family in 2014) OR 1% of your family income, whichever is greater. The fine increases dramatically each year after that. The fine is pro-rated by the number of months without coverage, although you are allowed be without health insurance for one period of time, as long as it is three months or less in duration. So, while the requirement kicks in on January 1, 2014, you technically must have health insurance coverage by March 31, 2014 to avoid the penalty. Check out this infographic from Kaiser Health Reform for more info on the fines.


2. You have a new place to shop for health insurance
. Each state has a new online marketplace where individuals and small businesses can buy health insurance. The deadline for coverage is the 15th of the month. For example, if you purchase insurance by March 15, coverage will start April 1. Open enrollment for private health insurance plans ends March 31, 2014. Public health insurance plan enrollment will remain open.

Is eligibility for public health insurance expanding?
Each state operates a Medicaid program that provides health coverage to lower-income people, families and children, the elderly and people with disabilities (in Minnesota, it’s called Medical Assistance). To learn more about your state’s Medicaid program, please visit http://www.medicaid.gov. All states do NOT have to expand their Medicaid program. However, part of the law includes funding for states that wish to expand their program to cover those who earn less than 138% of the “federal poverty level (FPL)” (approximately $15,500 for an individual and $32,000 for a family of four). Eligibility is simply based on income; there is no limit on assets. Many are still making their decision, some have chosen not to participate, and other state’s Medicaid programs will expand.

For Artists in Minnesota: Minnesota is participating in the expansion. Eligibility for Minnesota’s Medical Assistance (MA) program will expand from 75% of the FPL to 138% of the FPL for adults without dependents, parents and young adults aged 19-20; up to 275% of the FPL for kids aged 2 – 18; 278% FPL for pregnant women; and up to 283% FPL for children up to age 2. To find out more about your state’s decision to expand Medicaid, check out this map.

You may be wondering where MinnesotaCare fits into this picture (after all, many who have MinnesotaCare today would qualify for Medical Assistance (MA), or be eligible for subsidies to purchase a private plan on the exchange in 2014). MinnesotaCare is still operating in 2014 covering those who do not qualify for MA, but who have incomes up to 200% of the FPL for adults without dependents, children ages 19-20 and parents.

What's a health insurance exchange?
Each state has its own health insurance exchange. Don’t be fooled by the word “exchange.” In realty, it’s just an online store where individuals, families and small businesses* can compare and purchase health insurance. Minnesota’s exchange is named MNsure . To locate your state’s exchange, click here.

The state exchange is a new way to give individuals and small businesses the same purchasing power that large groups have today. Besides private plans from insurers like Blue Cross and Aetna, you’ll also be able to see if you qualify for and enroll in public healthcare programs like Medicaid and the Children’s Health Insurance Program (CHIP). Please note this this is NOT the place you’ll go to enroll in Medicare for adults aged 65 and older. Check out this video from the MNsure (Minnesota Health Insurance Exchange) to learn more.

If you’re uncomfortable using the online system or would like additional assistance, brokers, agents and other assisters will be available to enroll you in a plan that’s available on the exchange.

You can start shopping for and purchasing health insurance on October 1, 2013 for coverage starting January 1, 2014. You must use your own state’s exchange. So, residents of Minnesota use MNsure (Minnesota’s exchange); residents of Wisconsin use the Wisconsin exchange.

*The definition of small businesses is based on state law. Minnesota defines small businesses as having 50 employees or less, whereas many other states define small businesses as 100 employees or less.

PLEASE NOTE: The exchange is sometimes compared to Orbitz or Travelocity (but for shopping for and purchasing health insurance instead of plane tickets). While the websites for purchasing a product are similar, purchasing health insurance can be more complex than purchasing a plane ticket. For advice on finding the right plan, please check out our Guide to Healthcare for Artists and the Artists Health Insurance Resource Center’s publications.

Do I have to purchase health insurance on the exchange?
Individuals, families and small businesses must purchase health insurance via the exchange in order to get tax credits or enroll in public healthcare programs like Medicaid. If you’re uncomfortable using the online system or would like additional assistance, you’ll still be able to get the tax credits you’re eligible for by having a broker, agent or other assister enroll you in a plan that’s available on the exchange. Others not receiving tax credits or enrolling in public programs like Medicaid can still get insurance through:

  • An employer
  • An insurance plan purchased on your own (not via the exchange) that is at least at the Bronze level (ages 30+) or a high-deductible health insurance plan (for young adults under 30 years old)
  • A grandfathered plan in existence before the health reform law was enacted
  • Medicare
  • TRICARE for military personnel and the veteran’s health program

This flowchart can help determine how you’ll likely obtain insurance in 2014.


3. You have new legal rights and may have access to tax credits.
Insurance companies will no longer be able to deny you, limit your benefits or charge you more for premiums because of a pre-existing condition (your health status). Tax credits are available to help subsidize the cost of health insurance premiums.

Do employers have to offer health insurance in 2014?
Update! This requirement has been delayed. Starting January 1, 2015, Employers that have 100 or more FTE (full-time employees), or an equivalent combination of full-time and part-time employees, will be penalized for failing to offer “adequate” coverage to their full-time employees; Starting January 1, 2016, employers that have 50 – 99 FTE, or an equivalent, will be penalized. A FTE is defined as a person who works, on average, 30 hours a week or more. Insurance is deemed “inadequate” if the coverage:

  • Is less than a Bronze-level plan for employees aged 30+
  • Is less than a catastrophic (high-deductible) insurance plan for employees less than 30 years old
  • Costs the employee more than 9.5% of their income for health insurance (for self-only coverage)

This flowchart from Kaiser Family Foundation helps navigate when and how much employers are penalized.

More information for employers with 50 or more FTE employees can be found here.

The Obama administration released a statement that these “employers must also offer coverage to dependents under 26 years of age (who do not have insurance offered through their own employer).” However, as of now, coverage for dependents does not seem to be subject to the same standards, listed above, concerning “adequate” coverage. There is also no employer requirement to cover spouses. Please stay tuned for more information on this!

What tax credits am I eligible for?
For individuals and families: If your employer does not offer “adequate” health insurance (please see the previous question for definition of “adequate”), you may be eligible for a tax credit to purchase health insurance on the exchange. The tax credit is advanceable, so it can lower your premiums each month instead of at the end of the year when you claim it on your tax return.

The easiest way to determine your eligibility is to go to your state’s health insurance exchange, type in info about your income and household, and see what you qualify for.

Eligibility for a tax credit is based on your annual individual or household income and where it falls in relation to the government’s definition of the “federal poverty line (FPL).” You may be eligible for a tax credit if your income is between 100% and 400% of the FPL (in 2013, this was $11,490 – $45,960 for individuals; $23,550 – $94,200 for a family of four) and if you do not have access to other “adequate” coverage via an employer or public healthcare program (like Medicaid). To learn where your annual income falls on the FPL, check out this table from Families USA.

The tax credit works by covering any premium costs that exceed a certain percentage of your family income. While you do not have to purchase a Silver level plan to get the tax credit, this chart provides an example of how the tax credit works. For those purchasing a SILVER-LEVEL PLAN:

Your income as a percentage of the federal poverty level (FPL): You may be eligible for a tax credit to cover any Silver-level premium costs that go beyond this percentage of your income:
100 – 133% 2%
133 – 150% 3 – 4%
150 – 200% 4 – 6.3%
200 – 250% 6.3 – 8.1%
250 – 300% 8.1 – 9.5%
300 – 400% 9.5%

For small businesses: Small employers with less than 25 employees can get a tax credit if 1) they pay more than 50% of health insurance premiums for their employees and 2) if their employees have average wages of less than $50,000 a year. These credits became available in 2010 at 25% (for non-profits) to 35% and will go up to 35% (for non-profits) to 50% in 2014. Click here for more info and to claim the credit for 2013. Small businesses must get coverage through their state exchange to get the credit in 2014.

How much will I pay for health insurance on the exchange?

Insurers are able to charge premiums based on your age, family composition and if you use tobacco. Starting in 2014, insurers are NOT allowed to vary premiums based on pre-existing conditions, pregnancy, disability or gender. Your premium cost will still depend on the type of health insurance plan you qualify for, such as Medicaid or private health insurance, as well as your eligibility for tax credits. Just like today, you’ll also typically pay more for plans with lower deductibles that cover more of your healthcare costs.

The easiest way to know how much you’ll pay is to login to your state’s health insurance exchange, enter information about your household and income and see what options you have.

So how does the tax credit lower your premiums? You may either receive an advance on the tax credit (which lowers your premiums every month) or receive the whole tax credit, in the form of a rebate, when you file your taxes. If you choose to get an advancement on the credit, it’s based on your projected income; if you received an advance on the tax credit and your income was less than what was projected, you would get a rebate; if you got an advance on the credit and your income is more than what was projected, you must pay the difference back.

Once you have health insurance, the law prohibits dollar limits on your yearly and limetime spending for most healthcare services that are covered under your plan. For more information on lifetime and annual limits, please click here.

What else should I know about this law?
In March 2010, the government passed the Patient Protection and Affordable Care Act (PPACA), often referred to as the “health reform law” or “Obamacare.” One of the law’s many provisions is the individual health insurance requirement, but other parts of the law have already gone into effect. These include:

  • Insurance providers must offer preventive healthcare free-of-charge, as recommended based on gender and age.
  • Insurance providers can no longer deny health insurance (or limit benefits) for children under 19 because of pre-existing conditions.
  • Dependents can stay on their guardian’s health insurance plan until age 26.

We strongly encourage you to learn more about the law via these resources:
Healthcare.gov
Kaiser Family Foundation
MNsure (The Minnesota Health Insurance Exchange)


Would you like to help artists in your community connect to healthcare resources?
Check out our Artists’ Health Fair Replication Toolkit!

Professional Development Incubator Community CS Art Resources Health About Support