What are individual plans?

If you don't have coverage through an employer, you can buy an individual plan for yourself and your family during open enrollment.

Am I required to have coverage?

Starting Jan. 1, 2014, most people must have basic (minimum essential) coverage or pay a penalty. Coverage – purchased either inside or outside of Cover Oregon – must be in place by May 1, 2014 to avoid a penalty.

Who is not required to have health insurance?

  • Individuals and families whose income is low enough that they do not need to file federal income tax returns
  • People who would have to pay more than 8 percent of family income for insurance after taking premium tax credits and employer contributions into account
  • Individuals who have been uninsured for less than three months
  • People who are incarcerated
  • Undocumented immigrants
  • Members of American Indian tribes
  • People who do not obtain coverage because they belong to religious groups that object to insurance coverage, who belong to a health care sharing ministry, or who qualify for a hardship exemption

What happens if I don't have insurance?

Beginning with 2014 federal taxes, many people who can afford health insurance but decide not to buy it will owe penalties when they file their taxes in the spring of 2015.

What are the penalties?

The penalty grows each year as follows:

  • 2014: The greater of $95 per adult or 1 percent of taxable income above the filing limit. (The filing limit refers to the fact that federal income taxes are due from people who earn more than a threshold amount; the penalty is calculated on the amount above the threshold.)
  • 2015: The greater of $325 per adult or 2 percent of taxable income above the filing limit.
  • 2016: The greater of $695 per adult or 2.5 percent of taxable income above the filing limit.
  • After 2016: The tax penalty increases annually based on a cost-of-living adjustment.
  • Children: The penalty for a child is half that of an adult. Only the first two children are counted in calculating the penalty.

What happens if I don't pay the penalty?

  • You may be without coverage for up to three months without triggering the penalty. After that, you pay the penalty for any month that you are not covered.
  • If you are required to pay a penalty but do not, the IRS will send you a notice. If you do not pay the penalty, the IRS can reduce the amount of a future tax refund.



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Health guide

Guide to using health insurance in Oregon