Even with the implementation of the Affordable Care Act (ACA), many Americans remain uninsured or underinsured. The ACA's goals were to make health care insurance more affordable and accessible, to expand the Medicaid program and to support models designed to lower the costs of health care. 

Cost of Coverage

Depending on the state you live in, costs of purchasing health care insurance through the marketplace can be expensive. Many plans have monthly premiums with high annual deductibles. Coverage is generally for medical only. Vision and dental may not be covered in the plans offered in your state. Prescription coverage may be an extra cost or subject to an annual deductible. 

Even though mandated, many Americans choose to forego health insurance. While the penalties for not having health insurance can be steep, these penalties are often cheaper than the cost of purchasing insurance. Using a hypothetical person residing in Washington state, here is an example to illustrate this point:  

A 22-year-old single male (non-smoker) and recent college graduate started his first job working for a small company that does not offer health insurance. Marketplace premiums for available plans range in price from approximately $180 to $400 per month. Annual deductibles range from $1,500 to $7,500. Prescription coverage for the plans evaluated is subject to the annual deductible. 

The same individual is now 31 years-old, still working at the same company and earning an annual salary of $50,000. He is married with a 2-year-old child and has another child on the way. Premiums for available plans range in price from approximately $500 to $800 per month. Annual deductibles range from $5,000 to $10,500 for the family with prescription coverage for the plans evaluated being subject to the annual deductible.  

Having been at the company for his entire career and earning an annual salary of $65,000, the same male, age 60 (now a smoker), continues to buy insurance through the marketplace. His partner is disabled. Premiums for these plans range in price from approximately $1,300 to $1,800 per month. Annual deductibles for the plans evaluated range from $6,000 to $14,300 for the family. Some of the plans include prescription coverage. In the other plans, prescription coverage is subject to the annual deductible. 

Tax Penalties

When individuals add up the costs of the monthly health care insurance premiums and the additional costs of the annual deductibles, taking the tax penalty and opting out of signing up for an insurance plan appears to be a cheaper alternative. However, this is a very risky decision as one catastrophic illness or event can bankrupt individuals. At the writing of this blog, the tax penalty is 2.5% of your yearly household income or $2,085 per household. The consumer pays whichever is higher. More information about these penalties can be found here.

Family Nurse Practitioners

Family nurse practitioners should not assume that all patients have health care insurance. Choosing a plan is not a straight forward process and is difficult. Many states have agents and brokers who provide education about marketplace options. If available in your state, refer your patients to a broker. More information about marketplace agents and brokers can be found here.

Disclaimer: The information provided in this article is for discussion and illustrative purposes only and is not meant to guide or counsel any individual through the process of purchasing insurance through the open marketplace.