February 25, 2015

Tax Time - Special Enrollment Period for Health Coverage

Learn what's happening in the policy arena for CYSHCN - read Washington DC UpdateGiven that 2014 was the first time people were required to have health insurance or pay a fee with their taxes (unless subject to an exemption), it has been expected that some individuals would not appreciate the financial consequences of not having insurance until completing their 2014 tax returns. (An Urban Institute study found that more than 4 in 10 uninsured adults who may be subject to the penalty had heard little or nothing about it.)


In recognition of this, the Center for Medicare & Medicaid Services (CMS) on Friday announced a special enrollment period (SEP) for some individuals and families who did not have health coverage in 2014 and are subject to the fee or "shared responsibility payment" when they file their 2014 taxes. This SEP lasts from March 15 through April 30.

Those eligible for this special enrollment period are those who:


  • Live in a state with a Federally-facilitated Marketplace (FFM)
  • Currently are not enrolled in coverage through the FFM for 2015
  • Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.


Individuals who obtain coverage during this special enrollment period will still owe a fee for the months they were uninsured and did not receive an exemption in 2014 and 2015. This special enrollment period is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015.


The fee for failing to have insurance (unless one is exempted) is increasing next year, rising from $95 per adult plus $47.50 per child or 1 percent of income, whichever is greater, for 2014 to $325 per adult plus $162.50 per child under 18 or 2% of income for 2015.  Fees are prorated based on the number of months someone was uninsured. 


Consumers seeking to take advantage of the special enrollment period can find out if they are eligible by visiting https://www.healthcare.gov/get-coverage. Consumers can find local help at Localhelp.healthcare.gov or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in 150 languages. The call is free.