Don’t Get Stuck With the Penalty

By Sally Poblete, Founder and CEO, Wellthie


By Sally Poblete, Founder and CEO, Wellthie

Open Enrollment season is in full swing and more people than ever are getting the health insurance they need. Over one million people already enrolled in a 2016 health plan during the first two weeks of Open Enrollment, yet there are still more that remain uninsured or have not renewed a 2016 plan. Studies show that although most of the uninsured desire getting covered, financial challenges often inhibit them from thinking they can afford it. But with the tax penalty for the uninsured growing larger and larger each year, the cost of remaining without coverage may pose an even greater financial challenge.

Cost barriers are continuously the largest fear and uncertainty for those without health insurance coverage, but many aren’t considering this financial penalty they face if they do not choose coverage. Since the Affordable Care Act mandates that everyone obtain health insurance, there is a financial penalty for those that remain uninsured. This penalty will rise to the higher of 2.5 percent of individual’s household income or $695 per adult and $347.50 per child in 2016. This means that for all individuals earning less than $27,800, you will have to pay $695, while all those above this income are responsible for 2.5 percent of their household earnings.

By enrolling in a health plan, you can avoid the penalty and the out of pocket health care costs associated with it. Additionally, EmblemHealth — as well as other NY insurers — offers special assistance for individuals not eligible for Medicaid but earning less than $23,500 through offering Essential Plans costing approximately $20 or less per month. At $240 a year, that’s $455 cheaper than paying the penalty. Meaning for some, the penalty already comes in at a higher cost than getting covered.

Although there are some exemptions, most left without coverage in 2016 will have to pay this penalty. Apart from the real costs of the penalty, the value added in obtaining health insurance is immeasurable. Those with health insurance not only have enriched access to health care, but also avoid paying full price for the following essential health benefits:

  • Prescription drugs
  • Procedures in and outside of the hospital, including emergency room care
  • Well-baby visits and pediatric care, including vision and dental services
  • Lab tests
  • Mental health and substance use disorder treatment
  • Occupational, speech, and psychiatric therapy

The insured are also guaranteed free preventive health care services including screenings, counseling and vaccines. Additionally, insurance means you are protected for rainy days in a health emergency through sharing the total cost of care with your insurer. When it comes to getting covered during this year’s open enrollment, consider not only costs of getting stuck with the penalty, but also the benefits and protection of good health.

Wellthie is a health care technology company offering software-based solutions that help simplify health insurance.

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