No health insurance tax penalty

[mattwall45]

I'm looking for advice on dealing with the Obamacare no insurance penalty and possible getting the cheapest insurance (catastrophe insurance) to avoid being fined.

I resigned from a position at the end of Oct. that also ended my health insurance in Oct. I went to another position where it was MUCH more beneficial for me to be PRN working 60hrs+ a week and not considered a full time employee therefore I was not offered benefits/health insurance. I've made a great deal since that time so the penalty will be painful.
I emailed a few months back regarding Cobra or anything similar that the my current position might offer I was told nothing is offered.

1. There's a 3 month window to get coverage without being fined, but that window closes for me on Feb 1st right?
2. Is there insurance I can get that will count as being covered before then? Today is 1/21/17

I've been reading up on the current changes that occur regarding Obamacare, but it appears I'm still on the hook at the moment.

I live in FL if that helps.


I know it's intelligent to get insurance asap no matter who you are, but I'm a fit 31 year old who is a health care provider that exercises regularly. Still not smart, I know.

Any advise at all would be appreciated, thanks!

[jeff1949]

Have you applied at the ACA website to see what insurance might cost you?

If not I would begin here to get that info:

https://www.healthcare.gov/

After that process you can then decide if it is worth paying the penalty rather than getting the cheapest insurance offered there.

[dual]

President Trump just signed an executive order directing government agencies to minimize charges to individuals for the ACA penalty. You may want to wait on this to see what develops.

[Watty]

I know it's intelligent to get insurance asap no matter who you are, but I'm a fit 31 year old who is a health care provider that exercises regularly. Still not smart, I know.

+1

Since it sounds like you will not qualify for a subsidy then you can also get quotes directly from other companies and insurance agents.

Being fit does not protect you from a lot of problems.

[pintail07]

If you are healthy with no pre existion conditions you might look at STM form United Healthcare.

[Novine]

If I understand the penalty correctly, you're already on the hook for each month you don't have insurance. Each month you delay getting insurance, you're digging a deeper hole. The advice that you "wait and see" what happens with the penalty based on what may or may not happen in the future seems unwise, to say nothing of being uninsured if you have a serious medical condition.

[Quark]

President Trump just signed an executive order directing government agencies to minimize charges to individuals for the ACA penalty. You may want to wait on this to see what develops.

Waiting is not without risk. It is not clear how long one might have to wait to see what develops. The executive order is subject to applicable law, which would include the administrative procedures act to the extent applicable. Applicable law allows waivers for hardship, but just having to buy insurance isn't a hardship, and the law appears to require individual hardship applications. Even if some way could be found to waive on a blanket basis, it would likely require a lengthy notice and comment period. Eliminating the ACA penalty would increase the insurance costs of the remaining individuals (because healthier people are more likely to avoid insurance), which might raise issues. None of this is clear at the moment. See, for example, https://www.nytimes.com/2017/01/21/upsh ... .html?_r=0

As others have noted, going without insurance is rather risky. Being fit does not prevent serious accidents or other unforeseen, and expensive, health problems.

[michaeljc70]

I'm looking for advice on dealing with the Obamacare no insurance penalty and possible getting the cheapest insurance (catastrophe insurance) to avoid being fined.

I resigned from a position at the end of Oct. that also ended my health insurance in Oct. I went to another position where it was MUCH more beneficial for me to be PRN working 60hrs+ a week and not considered a full time employee therefore I was not offered benefits/health insurance. I've made a great deal since that time so the penalty will be painful.
I emailed a few months back regarding Cobra or anything similar that the my current position might offer I was told nothing is offered.

1. There's a 3 month window to get coverage without being fined, but that window closes for me on Feb 1st right?
2. Is there insurance I can get that will count as being covered before then? Today is 1/21/17

I've been reading up on the current changes that occur regarding Obamacare, but it appears I'm still on the hook at the moment.

I live in FL if that helps.


I know it's intelligent to get insurance asap no matter who you are, but I'm a fit 31 year old who is a health care provider that exercises regularly. Still not smart, I know.

Any advise at all would be appreciated, thanks!

COBRA would be through your FORMER employer, not current.

You say you are making good money yet seem to be basing this all around the penalty rather than your ability to afford insurance. If you are looking for a magic loophole, I guess it is to not owe anything at the end of the year and not pay the penalty and hope they can never come after you.

If everyone that thought they were healthy didn't buy insurance, where would we be? Insurance is specifically for unpredictable things.

EDIT: If you get hit by a car without insurance what will happen to all this money you are making in OT?

[michaeljc70]

My more specific comment is above, but in general in life I've found that whenever we know something "isn't smart" and then plan on doing it anyway, the decision should be re-examined.

[celia]

You are probably making "good money" because they aren't paying for benefits for you. Did you take that into account when you set up the new situation?

I'm guessing that good benefits can easily be another 30% of your salary.

If you can pick up COBRA with your old employer, you will likely have to make it retroactive to when you left. Yes, you would now be paying for insurance for months when it is impossible to use it (in the past). But it is the easiest short term fix you may have.

[Misenplace]

1. There's a 3 month window to get coverage without being fined, but that window closes for me on Feb 1st right?

I believe that you need to be insured for at least one day in January in order to claim the short term omission of coverage exclusion. So, Feb. 1 is too late. You must have insurance on January 31.

[bottlecap]

You will have to make a decision, but I have decided not to be a health care ninnie. If it makes financial sense, I'll pay it, otherwise we're self-insuring and taking a small risk.

In the current environment, without a decent employer plan, it makes sense to risk it. I hope that will change soon.

JT

[Phineas J. Whoopee]

1. There's a 3 month window to get coverage without being fined, but that window closes for me on Feb 1st right?

I believe that you need to be insured for at least one day in January in order to claim the short term omission of coverage exclusion. So, Feb. 1 is too late. You must have insurance on January 31.

The shared responsibility payment, as it's listed on tax forms, does not apply if the period without compliant health insurance is no longer than a cumulative two months during the calendar year.

I know in some circles it's popular to call taxes fines or punishments, but as the Chief Justice of the United States wrote it's simply a tax, and like many taxes one can make choices that influence whether one has to pay it. We talk about that all the time here when we post about tax-deferred and Roth accounts.

To go without health insurance is not illegal. One can choose coverage or to pay an additional tax. Both are legitimate under the Affordable Care Act. Nobody gets prosecuted either way.

PJW

[jucor]

You will have to make a decision, but I have decided not to be a health care ninnie. If it makes financial sense, I'll pay it, otherwise we're self-insuring and taking a small risk.

In the current environment, without a decent employer plan, it makes sense to risk it. I hope that will change soon.

JT

Actually, you're taking a large risk -- of the costs associated with an unexpected illness or injury. You often do not know if it makes "financial sense" to not have insurance until something happens, and then it is too late.

I had fairly minimal knee surgery from an injury last year -- it cost $18 k. Two months later I needed shoulder surgery -- another $15 k. I have a sister, non-smoker, fit, who developed lung cancer 2 years ago -- treatment has been many 10s of thousands. Totally unexpected, not in any of the high-risk groups. Virtually no one can really afford to self-insure for these sorts of things.

[theduke]

It seems as you had coverage Jan-Oct 2016. You can get a short term exemption for Nov and Dec. So you will not owe a shared responsibily payment for 2016 taxes. The no coverage for Jan 2017 and any later months will be on your 2017 taxes.

[Katietsu]

You qualify for the short gap exemption for 2016. The time you are uninsured in 2017 does not count against you. This is specific to the fact that your coverage gap is the last two months of 2016.

If you do not obtain coverage for at least one day in January, you are subject to a penalty under current rules. However, penalties are calculated on a month by month basis. So being insured for at least one day in February will limit your penalty to that for a single month.

If you are a health care provider, I am shocked that you can sleep at night. Having worked a part time job in the billing department for a pediatric hospital, I can tell you first hand that youth and pre-existing health do not preclude large hospital bills.

[bottlecap]

You will have to make a decision, but I have decided not to be a health care ninnie. If it makes financial sense, I'll pay it, otherwise we're self-insuring and taking a small risk.

In the current environment, without a decent employer plan, it makes sense to risk it. I hope that will change soon.

JT

Actually, you're taking a large risk -- of the costs associated with an unexpected illness or injury. You often do not know if it makes "financial sense" to not have insurance until something happens, and then it is too late.

I had fairly minimal knee surgery from an injury last year -- it cost $18 k. Two months later I needed shoulder surgery -- another $15 k. I have a sister, non-smoker, fit, who developed lung cancer 2 years ago -- treatment has been many 10s of thousands. Totally unexpected, not in any of the high-risk groups. Virtually no one can really afford to self-insure for these sorts of things.

I'd take my chances. I can pay or figure out a way to pay. If I can't, they can collect as they may.

Health insurance for me under an exchange plan is minimum $12k per year for the highest deductible available. I'll take the bet that my family won't use that much health care every year. I won't be a ninnie and pay any amount for insurance, no matter what.

To each is own.

JT

[Phineas J. Whoopee]

...
Health insurance for me under an exchange plan is minimum $12k per year for the highest deductible available. I'll take the bet that my family won't use that much health care every year. I won't be a ninnie and pay any amount for insurance, not matter what.

It seems as if you are against using health insurance at all, without regard to the shared responsibility payment or anything else, do I understand you correctly?

To each is own.

As indeed it should be.

PJW

[michaeljc70]

bottlecap wrote:
To each is own.

Not really. We have so many laws, regulations and taxes....

If OP does not buy insurance, these are the possible outcomes if he has a serious medical expense:

1) He pays it out of his savings. Given his stance on paying a much less insurance premium, this seems unlikely.

2) It falls on the other people that are footing the bill. AKA everyone that has insurance.

This is not even getting into the fact that real insurance only works when people buy it and not think they can guess when they will need it. That is the purpose of the penalty.

Personally, I would never go without medical insurance. I know people that do, but they have nothing to lose (no savings, investments, etc.)

[bottlecap]

...
Health insurance for me under an exchange plan is minimum $12k per year for the highest deductible available. I'll take the bet that my family won't use that much health care every year. I won't be a ninnie and pay any amount for insurance, not matter what.

It seems as if you are against using health insurance at all, without regard to the shared responsibility payment or anything else, do I understand you correctly?

To each is own.

As indeed it should be.

PJW

Not against it completely. It's a financial decision. Obviously the penalty complicates that decision, but at some point, even paying the penalty does not change the fact that you are paying far to much for far too little.

For me, paying an extra $9k a year over the penalty for the "privilege" of paying another $7,000 to $12,500 before a dime of health insurance kicks in is too much.

I understand that I could have a black swan health event, but if you total it over a working career, if I don't have such an event, I'm paying between $500,000 and $900,000 for insurance and/or health care and might never see a cent of true insurance benefit before I reach an age that Medicare kicks in. At some point, it's just not worth the cost. Until someone decides that, the cost will keep going up.

JT

[bottlecap]

This is not even getting into the fact that real insurance only works when people buy it and not think they can guess when they will need it. That is the purpose of the penalty.

And that's the thing. Healthcare insurance isn't real insurance anymore. It covers both the expected and the unexpected. And so the cost has skyrocketed.

Don't get me wrong, I know that health insurance hasn't been "actual" insurance for a long time. But at this point, all pretext is gone and we are just paying the insurance industry to pay our regular health care bills and they, unsurprisingly, have figured out a way to make us pay more than we ordinarily would.

JT

[michaeljc70]

...
Health insurance for me under an exchange plan is minimum $12k per year for the highest deductible available. I'll take the bet that my family won't use that much health care every year. I won't be a ninnie and pay any amount for insurance, not matter what.

It seems as if you are against using health insurance at all, without regard to the shared responsibility payment or anything else, do I understand you correctly?

To each is own.

As indeed it should be.

PJW

Not against it completely. It's a financial decision. Obviously the penalty complicates that decision, but at some point, even paying the penalty does not change the fact that you are paying far to much for far too little.

For me, paying an extra $9k a year over the penalty for the "privilege" of paying another $7,000 to $12,500 before a dime of health insurance kicks in is too much.

I understand that I could have a black swan health event, but if you total it over a working career, if I don't have such an event, I'm paying between $500,000 and $900,000 for insurance and/or health care and might never see a cent of true insurance benefit before you reach an age that Medicare kicks in. At some point, it's just not worth the cost. Until someone decides that, the cost will keep going up.

JT

First of all regardless of the deductible, the insurance company has networks and negotiates large discounts. For example, spouse had a CT scan. Bill was $2200, Insurance discount $2k. We pay $200.

Second, using that logic do you have car or homeowners insurance? Certainly it is unlikely your house will burn down or car will be totaled.

[bottlecap]

First of all regardless of the deductible, the insurance company has networks and negotiates large discounts. For example, spouse had a CT scan. Bill was $2200, Insurance discount $2k. We pay $200.

Second, using that logic do you have car or homeowners insurance? Certainly it is unlikely your house will burn down or car will be totaled.

In your example, something is amiss. I've had a CT scan with insurance. My responsibility was not negotiated down to anything near $200. At $200 the health care provider would be losing money. Apparently you have a Cadillac plan that either you or your employer pays a lot for.

In addition, the negotiated rates that insurance companies "get" you are higher than you would pay if you didn't have insurance. I know because I've gone without insurance and could compare. So your insurance isn't getting you any actual discount.

Finally, I don't pay between $12,000 and $25,000 per year for car insurance or homeowners insurance. You can bet if I did I would drop it in a heartbeat. Wouldn't you?

JT

[michaeljc70]

First of all regardless of the deductible, the insurance company has networks and negotiates large discounts. For example, spouse had a CT scan. Bill was $2200, Insurance discount $2k. We pay $200.

Second, using that logic do you have car or homeowners insurance? Certainly it is unlikely your house will burn down or car will be totaled.

In your example, something is amiss. I've had a CT scan with insurance. My responsibility was not negotiated down to anything near $200. At $200 the health care provider would be losing money. Apparently you have a Cadillac plan that either you or your employer pays a lot for.

In addition, the negotiated rates that insurance companies "get" you are higher than you would pay if you didn't have insurance. I know because I've gone without insurance and could compare. So your insurance isn't getting you any actual discount.

Finally, I don't pay between $12,000 and $25,000 per year for car insurance or homeowners insurance. You can bet if I did I would drop it in a heartbeat. Wouldn't you?

JT

I hardly have a Cadillac plan with a $7k deductible. It is true that due to insurance, there are certainly distortions of the "true" price of things. I can tell you that is what the EOB says. Another very recent example is Dr. charges $190, discount $100, I pay $90. Now people say, well I'll pay cash and negotiate. Hard to do in the back of an ambulance or in another emergency. Many providers just don't have that option as it is not a normal channel.

Well, my homeowners insurance and auto insurance are mandatory due to state law, my mortgage and my homeowners association regardless of price.

[Nate79]

There was a thread not too long ago where someone asked about self insuring for medical. Most felt it was a horrible idea putting their financial future in severe threat.

[michaeljc70]

There was a thread not too long ago where someone asked about self insuring for medical. Most felt it was a horrible idea putting their financial future in severe threat.

I think a lot of these people that say they will just pay it if something bad happens are fooling themselves (or others). The cost of a minor injury can be quite large. A broken limb can be over $15k. A family member had a heart valve problem and that was over $500k. HIV medications costs tens of thousands of dollars at retail a year.

[bottlecap]

First of all regardless of the deductible, the insurance company has networks and negotiates large discounts. For example, spouse had a CT scan. Bill was $2200, Insurance discount $2k. We pay $200.

Second, using that logic do you have car or homeowners insurance? Certainly it is unlikely your house will burn down or car will be totaled.

In your example, something is amiss. I've had a CT scan with insurance. My responsibility was not negotiated down to anything near $200. At $200 the health care provider would be losing money. Apparently you have a Cadillac plan that either you or your employer pays a lot for.

In addition, the negotiated rates that insurance companies "get" you are higher than you would pay if you didn't have insurance. I know because I've gone without insurance and could compare. So your insurance isn't getting you any actual discount.

Finally, I don't pay between $12,000 and $25,000 per year for car insurance or homeowners insurance. You can bet if I did I would drop it in a heartbeat. Wouldn't you?

JT

I hardly have a Cadillac plan with a $7k deductible. It is true that due to insurance, there are certainly distortions of the "true" price of things. I can tell you that is what the EOB says. Another very recent example is Dr. charges $190, discount $100, I pay $90. Now people say, well I'll pay cash and negotiate. Hard to do in the back of an ambulance or in another emergency. Many providers just don't have that option as it is not a normal channel.

Well, my homeowners insurance and auto insurance are mandatory due to state law, my mortgage and my homeowners association regardless of price.

My actual real-life experience as recently as the last few months has been Dr. charges $220, insurance negotiates down to $120. Next visit my wife says, we dropped insurance, receptionist says then it will be $67.

No negotiatation. Doctor only wants $67. But with insurance, insurance gets your $1,000 monthly premium, Dr. gets $120. Win-win for everyone but you.

JT

P.S. Wife says it was $59, not $67. More than half price. And we didn't have to wait 3 months to find out what it would cost.

[Nick341981]

Not recommending this at all, but if the majority of your assets were in a 401k or a Roth and you had a homestead exemption on your house couldn't you file bankruptcy and most of your assets be protected in the event of a bad health event? This of course doesn't even take into account that many people are waiting till an issue comes up then signing up for insurance. What am I missing?

[mattwall45]

I appreciate all the responses. It's not my intentions to avoid health insurance. I just switched over to this job rather quickly. I've been working 60+ hrs in a VERY busy ER and moved to this area for the job. It was hard to get to it honestly.
I'm an ER physician assistant. They're paying me a little over double time to be here. ER PA's make from $50-$80 an hour to give everyone reference.

I will get a very high deductible health insurance, but was looking for advice on where to get it and if I can get it done before 2/1/17. Doesn't seem so, but I wanted to check. I'm going to be on the hook for a good chunk for January alone.

If you can pick up COBRA with your old employer, you will likely have to make it retroactive to when you left. Yes, you would now be paying for insurance for months when it is impossible to use it (in the past). But it is the easiest short term fix you may have.

Is this possible? This would save me some $. After review I might have gone 3 months not 2 and be on the hook for the max penalty in taxes for 2016. Yes I'm an idiot

[covertfantom]

I think it's pretty obvious that insurance as it is currently structured is there to subsidize the sickest of society at the cost of the healthy. The truth is that since insurance companies can't deny you coverage and can't put a cap on your expenditures, the only time you have to bear the cost is when the change in your health is sudden and requires immediate and expensive treatment. Otherwise, if your care is chronic (i.e. AIDS medication), being uninsured prior to diagnosis is not a death sentence for your bank account since you could enroll for health insurance the following year. You going onto the 'rolls' at that point simply passes your responsibility to everyone else in the healthcare system.

It's not really the way healthcare should work in this country and I'm not sure I want to take advantage of others like that. To each his/her own.

[cherijoh]

If I understand the penalty correctly, you're already on the hook for each month you don't have insurance. Each month you delay getting insurance, you're digging a deeper hole. The advice that you "wait and see" what happens with the penalty based on what may or may not happen in the future seems unwise, to say nothing of being uninsured if you have a serious medical condition.

+1

I'd be more worried about lack of health care coverage than the tax penalty.

OP - you only have 60 days from a qualifying event to sign up for COBRA so it looks like that window has closed for you.

[Quark]

...And that's the thing. Healthcare insurance isn't real insurance anymore. It covers both the expected and the unexpected. And so the cost has skyrocketed....

Every other major country in the world has some means of covering both the expected and the unexpected at significantly lower costs than in the US. Therefore, it would not seem the covering both the expected and unexpected is the culprit in costs.

[cherijoh]

First of all regardless of the deductible, the insurance company has networks and negotiates large discounts. For example, spouse had a CT scan. Bill was $2200, Insurance discount $2k. We pay $200.

Second, using that logic do you have car or homeowners insurance? Certainly it is unlikely your house will burn down or car will be totaled.

In your example, something is amiss. I've had a CT scan with insurance. My responsibility was not negotiated down to anything near $200. At $200 the health care provider would be losing money. Apparently you have a Cadillac plan that either you or your employer pays a lot for.

In addition, the negotiated rates that insurance companies "get" you are higher than you would pay if you didn't have insurance. I know because I've gone without insurance and could compare. So your insurance isn't getting you any actual discount.

Finally, I don't pay between $12,000 and $25,000 per year for car insurance or homeowners insurance. You can bet if I did I would drop it in a heartbeat. Wouldn't you?

JT

I hardly have a Cadillac plan with a $7k deductible. It is true that due to insurance, there are certainly distortions of the "true" price of things. I can tell you that is what the EOB says. Another very recent example is Dr. charges $190, discount $100, I pay $90. Now people say, well I'll pay cash and negotiate. Hard to do in the back of an ambulance or in another emergency. Many providers just don't have that option as it is not a normal channel.

Well, my homeowners insurance and auto insurance are mandatory due to state law, my mortgage and my homeowners association regardless of price.

My actual real-life experience as recently as the last few months has been Dr. charges $220, insurance negotiates down to $120. Next visit my wife says, we dropped insurance, receptionist says then it will be $67.

No negotiatation. Doctor only wants $67. But with insurance, insurance gets your $1,000 monthly premium, Dr. gets $120. Win-win for everyone but you.

JT

P.S. Wife says it was $59, not $67. More than half price. And we didn't have to wait 3 months to find out what it would cost.

Good luck with that plan if you have a serious illness or require hospitalization.

[bluebolt]

President Trump just signed an executive order directing government agencies to minimize charges to individuals for the ACA penalty. You may want to wait on this to see what develops.

There is some thought that hardship exemptions will be automatically granted now, so that's a possibility.
I would only recommend that if you can obtain catastrophic coverage and/or are wealthy enough to self-insure.

[veggivet]

Probably safe to say at this point that enforcing penalties for not having health insurance will not be high on the list of priorities in this administration, if it makes the list at all...

[Katietsu]

To OP, please reread some of the responses including my earlier response. You are not on the hook for any penalty for 2016 even if you never sign up for health insurance. And if you begin insurance on 2/1/2017, your penalty for January 2017 will likely be less than $250.

[scottwood2]

Also check the cost of COBRA too. I just checked mine at work and it is more expensive than ACA insurance.

[dwickenh]

To OP, please reread some of the responses including my earlier response. You are not on the hook for any penalty for 2016 even if you never sign up for health insurance. And if you begin insurance on 2/1/2017, your penalty for January 2017 will likely be less than $250.

It is possible to get a short term exemption if the person was without MEC coverage for less than 3 consecutive months. This goes away on the third month.

Being covered on the first day of the month makes that month count as a covered month.

Good luck on your decision, and check with your tax person for your current penalty status.

Dan

[lazydavid]

The penalty is deducted from your tax refund, but is NOT added to your total tax liability. No refund=no penalty. If you truly don't want insurance (like most others, I don't advise this course of action), adjust your withholding so you will owe a small amount with your 2017 return.

[montanagirl]

The penalty is deducted from your tax refund, but is NOT added to your total tax liability. No refund=no penalty. If you truly don't want insurance (like most others, I don't advise this course of action), adjust your withholding so you will owe a small amount with your 2017 return.

That's not right. It is added to total tax liability on line 61 of the 1040.

[lazydavid]

That's not right. It is added to total tax liability on line 61 of the 1040.

While this is technically true--it does go on the form--it's only a liability if you actually have to pay it. And you don't. See here:

https://www.healthcare.gov/fees/fee-for ... g-covered/

What happens if I don't pay the fee?

The IRS will hold back the amount of the fee from any future tax refunds. There are no liens, levies, or criminal penalties for failing to pay the fee.

That's what I mean about it not being a tax liability. It's a fee that gets added in with some other tax liabilities. But unlike actual taxes, it doesn't trigger an audit or jail sentence when you refuse to pay. If line 74 says you owe $800, and $500 of that is on line 61, include a check for $300 with your return and you're done.

[EyeDee]

.
You need to make time to get signed up for health insurance by the end of January 2017 to get it done during the open period for 2017 or you may have to wait until 2018 for health insurance. Make time to get this resolved in January.

See: https://www.healthcare.gov/

I will get a very high deductible health insurance, but was looking for advice on where to get it and if I can get it done before 2/1/17. Doesn't seem so, but I wanted to check. I'm going to be on the hook for a good chunk for January alone.

[SuzBanyan]

That's not right. It is added to total tax liability on line 61 of the 1040.

While this is technically true--it does go on the form--it's only a liability if you actually have to pay it. And you don't. See here:

https://www.healthcare.gov/fees/fee-for ... g-covered/

What happens if I don't pay the fee?

The IRS will hold back the amount of the fee from any future tax refunds. There are no liens, levies, or criminal penalties for failing to pay the fee.

That's what I mean about it not being a tax liability. It's a fee that gets added in with some other tax liabilities. But unlike actual taxes, it doesn't trigger an audit or jail sentence when you refuse to pay. If line 74 says you owe $800, and $500 of that is on line 61, include a check for $300 with your return and you're done.

Not done, unless you never have a tax refund, ever. From your link: "The IRS will hold back the amount of the fee from any future tax refunds."

[Maverick3320]

...And that's the thing. Healthcare insurance isn't real insurance anymore. It covers both the expected and the unexpected. And so the cost has skyrocketed....

Every other major country in the world has some means of covering both the expected and the unexpected at significantly lower costs than in the US. Therefore, it would not seem the covering both the expected and unexpected is the culprit in costs.

And one of the main reasons for the higher healthcare costs in the US is higher salaries for medical professionals. Since OP is a medical professional, I'm not sure this is the right place for this argument.

[an_asker]

[...]
No negotiatation. Doctor only wants $67. But with insurance, insurance gets your $1,000 monthly premium, Dr. gets $120. Win-win for everyone but you.

JT

P.S. Wife says it was $59, not $67. More than half price. And we didn't have to wait 3 months to find out what it would cost.

I received an invoice last week from a doctor visit with previous insurance - literally two years ago. The service date is 1/21/2015!! I guess the doctors (and/or medical insurance) have no statute of limitations. What is really frustrating about this invoice is that I received two (or three even) other invoices from the same doctor's office back in 2015, I had issues with them as they didn't really match up with the EOBs. I went back and forth for a couple of weeks with the billing department - they never were able to address the inconsistencies and I didn't pay. After receiving the invoice repeatedly for nearly six months, I finally called them and asked, "Are these the only invoices? There is nothing left, right?" And the billing lady replied, "Yes, there is nothing else. Your account is paid off!" And now another invoice!!

That said, call me a ninnie (well, you already have!), but I do have health insurance (I pat myself on the back and say that I am contributing to society ... though it is more like Paul paying Peter).

[LiterallyIronic]

My actual real-life experience as recently as the last few months has been Dr. charges $220, insurance negotiates down to $120. Next visit my wife says, we dropped insurance, receptionist says then it will be $67.

No negotiatation. Doctor only wants $67. But with insurance, insurance gets your $1,000 monthly premium, Dr. gets $120. Win-win for everyone but you.

JT

P.S. Wife says it was $59, not $67. More than half price. And we didn't have to wait 3 months to find out what it would cost.

This has been my experience, too. I have health insurance through my work. But when I go to a doctor, I always tell them I don't have health insurance. They always chop the price big-time. If I happen to use the hospital network, they will even tack on a 40% discount if I pay that day. Some day, something horrific might happen to me, and that's the day I'll say I have health insurance, the $25,000 medical procedure. But if it's for a $80 ear irrigation, for example, I'm paying cash.

[Novine]

"Health insurance for me under an exchange plan is minimum $12k per year for the highest deductible available. I'll take the bet that my family won't use that much health care every year. I won't be a ninnie and pay any amount for insurance, no matter what."

According to Kaiser, the average cost of an employer-provided family health insurance plan is $17,000 so even at $12,000, you're getting it at a discount as compared to the cost for those getting it through their workplace. I have no doubt that there's savings to be found in health care. But the idea that everyone can get all the benefits of the ACA including:

- Guarantee of coverage despite pre-existing conditions
- No lifetime limits on coverage
- Bans on rescission where insurance companies cancel coverage when you get sick
- Limits on maximum out-of-pocket costs

but that it can be done for pre-ACA prices seems like a pipe dream. None of those benefits existed in pre-ACA individual plans and it's why insurers were able to offer those plans for much less than what they charged for pre-ACA group plans offered by employers which were required to provide those benefits. If you can deny coverage to sick people or drop people when they get sick or cap their benefits when their care gets too expensive, it's easy to offer those plans for less.

[michaeljc70]

My actual real-life experience as recently as the last few months has been Dr. charges $220, insurance negotiates down to $120. Next visit my wife says, we dropped insurance, receptionist says then it will be $67.

No negotiatation. Doctor only wants $67. But with insurance, insurance gets your $1,000 monthly premium, Dr. gets $120. Win-win for everyone but you.

JT

P.S. Wife says it was $59, not $67. More than half price. And we didn't have to wait 3 months to find out what it would cost.

This has been my experience, too. I have health insurance through my work. But when I go to a doctor, I always tell them I don't have health insurance. They always chop the price big-time. If I happen to use the hospital network, they will even tack on a 40% discount if I pay that day. Some day, something horrific might happen to me, and that's the day I'll say I have health insurance, the $25,000 medical procedure. But if it's for a $80 ear irrigation, for example, I'm paying cash.

What if the doctor orders tests? Lab work? I had a routine physical and the lab work was over $1000 (billed rate). If the doctor says you need a test do you take out your cell, ask him what lab he uses, call them and try to negotiate?

I had a friend that complained about how expensive a charge was at a hospital (they rushe'd a result that didnt need to be incuring a lot more $$$$) . They said they would write it off. He said he didn't want them to write it off, he wanted to pay what was fair. They said they don't do that. You pay it all or pay none.

Getting back to the original question, I am not sure why insurance for a 31 yo would be so expensive. I live in a big city and am 46 and my policy is under $400 a month. It was under $300 last year.

[michaeljc70]

You will have to make a decision, but I have decided not to be a health care ninnie. If it makes financial sense, I'll pay it, otherwise we're self-insuring and taking a small risk.

In the current environment, without a decent employer plan, it makes sense to risk it. I hope that will change soon.

JT

Actually, you're taking a large risk -- of the costs associated with an unexpected illness or injury. You often do not know if it makes "financial sense" to not have insurance until something happens, and then it is too late.

I had fairly minimal knee surgery from an injury last year -- it cost $18 k. Two months later I needed shoulder surgery -- another $15 k. I have a sister, non-smoker, fit, who developed lung cancer 2 years ago -- treatment has been many 10s of thousands. Totally unexpected, not in any of the high-risk groups. Virtually no one can really afford to self-insure for these sorts of things.

I'd take my chances. I can pay or figure out a way to pay. If I can't, they can collect as they may.

Health insurance for me under an exchange plan is minimum $12k per year for the highest deductible available. I'll take the bet that my family won't use that much health care every year. I won't be a ninnie and pay any amount for insurance, no matter what.

To each is own.

JT

As far as bets go, medical expenses is the number one cause of bankruptcy in the US.

[mattwall45]

To OP, please reread some of the responses including my earlier response. You are not on the hook for any penalty for 2016 even if you never sign up for health insurance. And if you begin insurance on 2/1/2017, your penalty for January 2017 will likely be less than $250.

https://www.healthcare.gov/exemptions-t ... /short-gap

If your coverage gap crosses calendar years, the months without coverage of the second tax year aren’t counted for the exemption for the first tax year. But the uncovered months from the first year are counted for the exemption for the second tax year.
Example: Let’s say you didn’t have qualifying coverage November 2015, December 2015, and January 2016. You’re eligible for the short gap exemption for 2015. But for the 2016 tax year, you’re not eligible for the short gap exemption for January 2016 because you didn’t have coverage for three consecutive months – from November 2015 through January 2016.

[OT comment removed by admin LadyGeek]


so my question is, is there insurance that I can lock in for a day of January. Say starting January 31st? otherwise I pay around 1k for the month in penalty.

of the responses including my earlier response. You are not on the hook for any penalty for 2016 even if you never sign up for health insurance. And if you begin insurance on 2/1/2017, your penalty for January 2017 will likely be less than $250.

I'm pretty confident they'll find a way somewhere down the line to get that $ back. I appreciate the idea though.

So to be clear, I'm not debating insurance or healthcare cost. I just need advice on how to deal with my situation regarding the tax penalty and the cheapest insurance that will pay for any catastrophe.