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Health insurance

Health insurance affects everyone, whether you have it or not. Maybe you don’t have health insurance, but wish you did after experiencing an unexpected illness or accident. Or maybe you do have it, but you don’t know what’s covered. As a hot-button political topic, it’s important to recognize that health care laws are changing all the time, especially with each new administration. The article below discusses some of the more important legal aspects of health insurance.

How Health Insurance Works

When you have health insurance, typically you (or your employer) pays a monthly amount to the insurance company called a premium. If you incur covered medical expenses, you first pay whatever the deductible amount is, if applicable. The insurance company then pays for certain percentages of different types of medical care – for example, 80 percent of medically necessary surgical operations. You would then pay the other 20 percent, for example, until you reach your out-of-pocket maximum.

The insurance company hopes to insure as many healthy people as they can, because they’re less likely to use it, and their premiums help cover the costs of those who are less healthy and use their insurance more. Meanwhile, Medicare and Medicaid are federal programs that provide insurance to people over 65 (Medicare), low-income individuals (Medicaid), and many others.

Am I Required to Have Health Insurance?

Under current law, the answer for most people is yes, you are required to have health insurance. This is known as the “individual mandate” under the Affordable Care Act (ACA), or “Obamacare.” To fulfill this requirement, you must be enrolled in a plan that meets the minimum essential coverage standard. If you don’t have qualifying health insurance, you may be required to pay a fee called the “individual shared responsibility payment,” unless you qualify for one of the exemptions under the ACA.

How Much Is the Fee for Not Having Health Insurance?

The fee for not having insurance is calculated in one of two ways, and you pay whichever is greater. The first calculation is a flat dollar fee which was $695 per adult and $347.50 per child under 18, with a maximum of $2,085 in 2016. The second type is calculated as a percentage of income. For that same tax year, this amount was 2.5 percent of the portion of your income above the tax filing requirement ($10,350 for individuals filing in 2017, $20,700 for joint filers). The maximum amount under this calculation is the yearly premium cost for the national average price of a Bronze plan ($2,676 in 2016).

If you had insurance for part of the year, you would pay 1/12th of the annual amount for each month you or one of your dependents didn’t have coverage. So, for example, if you’re single, made $50,000, and didn’t have insurance in 2016, you would pay 2.5 percent of $39,650, which is $991.25 (and greater than $695, so you wouldn’t pay the flat fee instead). If you had coverage for three months of the year, you would pay 9/12 of that amount, or $743.44. If you’re uninsured for only one or two months of the year, you don’t have to pay the fee.

Exemptions from the Health Insurance Requirement

There are a number of exemptions from the requirement to have health insurance. If you’re not required to file a federal income tax return because your income is below the threshold amount, you’re automatically exempt. Otherwise, you need to claim the exemption when you file your taxes, although some exemptions must also be granted ahead of time. Some exemptions you may qualify for include the following:

·         Coverage is unaffordable: The cost of a bronze plan is more than a certain percentage of your actual household income.

·         Short coverage gap: You lacked health insurance for no more than two consecutive months.

·         Noncitizens and citizens living abroad: Some individuals not legally present in the U.S., and certain citizens living abroad for at least 330 full days during the year are exempt.

·         Hardship: You experienced certain circumstances that prevented you from obtaining coverage, such as homelessness, foreclosure, eviction, domestic violence, death of a close family member, and unpaid medical bills.

Is My Employer Required to Provide Health Insurance?

Not all employers have to provide health insurance to their employees. As of 2017, employers who had an average of at least 50 full-time employees during the preceding year must offer minimum essential coverage or pay a fee to the IRS. Employers and companies that do provide insurance must also abide by anti-discrimination laws as well as requirements of the Employee Retirement Income Security Act (ERISA) and the Health Insurance Portability and Accountability Act (HIPAA). These laws are meant to protect employees and plan beneficiaries.

What Does My Insurance Company Have to Cover?

As mentioned, health insurance laws change all the time. However, as of 2017, insurance companies must abide by the requirements of the ACA. These include the following provisions:

·         Individuals may not be denied coverage based on pre-existing conditions, including pregnancy.

·         Dependents can remain on their parents’ insurance plans until they turn 26.

·         Plans must cover certain preventative services for free, including shots and screening tests.

·         Plans may not have lifetime or yearly dollar limits on coverage of essential health benefits

·         Companies may not cancel your health insurance just because you get sick.

·         Plans must also cover certain breastfeeding equipment, birth control methods, and mental health and substance abuseservices.

However, certain grandfathered health plans may be exempt from many of the ACA’s requirements.

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David Patrick Mitchell
David Patrick Mitchell

101 E. Kennedy Blvd, Suite 1700, Tampa, FL 33602

Bar #67249(FL)     License for 2009 years Member in Good Standing

Practice Areas: Consumer protection | Health insurance | Insurance fraud
Douglas Barry Melamed
Douglas Barry Melamed

1200 South Pine Island Road, Suite 170, Plantation, FL 33324

Bar #150002(FL)     License for 1998 years Member in Good Standing

Practice Areas: Defective and dangerous products | Health insurance | Litigation | Medical malpractice | Personal injury | Wrongful death
Linsey Marie Pyles
Linsey Marie Pyles

2020 6th Ave. Ste. 768, Seattle, WA 98121

License for 2019 years Active

Practice Areas: Health insurance
Cathleen Ann Scott
Cathleen Ann Scott

Jupiter Gardens250 S. Central Boulevard, Suite 104, Jupiter, FL 33458

Bar #135331(FL)     License for 1998 years Member in Good Standing

Practice Areas: Arbitration | Civil rights | Discrimination | Employee benefits | Employment and labor | Health care | Health insurance | Libel and slander | Litigation | Mediation | Sexual harassment | Workers compensation | Wrongful termination
Joseph Vincent Priore
Joseph Vincent Priore

200 South Andrews Avenue Suite 100, Fort Lauderdale, FL 33301

Bar #348820(FL)     License for 2000 years

Practice Areas: Business | Health care | Health insurance | Insurance | Intellectual property | Litigation
Carol Ann Caldwell
Carol Ann Caldwell

6 Perpall Street, St. Augustine, FL 32084

Bar #87246(FL)     License for 1996 years Member in Good Standing

Practice Areas: Child custody | Child support | Divorce and separation | Elder law | Family | Health insurance | Marriage and prenuptials
Peter Christopher Wegner
Peter Christopher Wegner

3510 Kraft Road Suite 200, Naples, FL 34105

Bar #37896(FL)     License for 2007 years Member in Good Standing

Practice Areas: Business | Commercial real estate | Contracts and agreements | Corporate and incorporation | Estate planning | Government contracts | Health insurance | Residential real estate | Tax | Venture capital
Andrew Richard McCumber
Andrew Richard McCumber

4830 W Kennedy Blvd Ste 300, Tampa, FL 336092521

Bar #907138(FL)     License for 1991 years

Practice Areas: Appeals | Defective and dangerous products | Health insurance | Insurance | Litigation | Medical malpractice
Caleb Samuel Kenyon
Caleb Samuel Kenyon

102 NW Second Avenue, Gainesville, FL 32601-5205

Bar #1002297(FL)     License for 2017 years Member in Good Standing

Practice Areas: Administrative law | Criminal defense | Health care | Health insurance | Licensing | Litigation | Sexual harassment | White collar crime | Wrongful termination
Jeffrey Michael Liggio
Jeffrey Michael Liggio

Barristers Building1615 Forum Place, Suite 3B, West Palm Beach, FL 33401

Bar #357741(FL)     License for 1982 years Member in Good Standing

Practice Areas: Class action | Health care | Health insurance | Insurance | Life insurance | Litigation | Personal injury | Wrongful death
Brian Alan Coury
Brian Alan Coury

2692 W. Lake Mary Blvd., Ste. 1010, Lake Mary, FL 32746-3535

Bar #896225(FL)     License for 1991 years

Practice Areas: Health insurance | Insurance | Life insurance | Litigation | Medical malpractice | Personal injury | Wrongful death
David Louis Orosz
David Louis Orosz

2072 Victoria Ave., Fort Myers, FL 33901

Bar #134427(FL)     License for 1971 years Member in Good Standing

Practice Areas: Elder law | Estate planning | Guardianship | Health insurance | Probate

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