4. Those Penalties Can Add Up
The tax penalties won't kick in until you file your 2014 taxes in 2015, but they can add up, and they'll grow over time.
The penalty for not having health insurance in 2014 will be 1% of your annual income or $95 per adult, whichever is higher. If you pay $95 per person, you'll also have to pay a penalty of $47.50 for each uninsured child under 18 in 2014, up to a maximum amount per family of $285. In practical terms, though, most people who have to pay a penalty will fall into the 1% category. That’s 1% of your household income above the tax filing threshold of $10,150 for an individual.
In the next 2 years, that penalty gets stiffer: In 2015 it will be 2% of income or $325 per person. In 2016 it will be 2.5% of income or $695 per person, whichever is higher.
5. Premiums May Not Tell the Whole Story
Are those Marketplace policies a good deal? It's hard to say. A January report from PriceWaterhouseCoopers found that premiums for Marketplace policies are cheaper, on average, than those offered through employers. PriceWaterhouseCoopers's Ceci Connolly told Marketplace.org that even when you factor in all the out-of-pocket costs, the average top-tier gold and platinum plans are similar to employer plans.
But why are deductibles so high, rising into thousands of dollars a year in some cases?
"An insurance company needs to collect more money in terms of premiums than it expects to pay out," Bowblis says. "One way to make sure this happens is to either have low premiums and high cost sharing, or high premiums and low cost sharing." The Obama administration pushed for lower premiums, he says. "But low premiums equal high deductibles."
6. You May Fall Through the Medicaid Gap
An estimated 5 million low-income people aren't getting financial help to buy insurance coverage, because their incomes aren't high enough to earn a subsidy from the federal government. But if their state hasn't expanded Medicaid, they may make too much to qualify for that program.
It's an unusual situation, to make too little to get help from the feds but too much to get help from the state. That's the way things stand, though, in the 25 states that have declined to expand Medicaid.
"We need to take the long view," says Aaron Katz, a principal lecturer at the University of Washington who studies health care expenses. "It took 17 years after original enactment of Medicaid for all 50 states to join in. I expect the vast majority of states to adopt the expansion in the next 5-10 years. The pressure from hospitals, doctors, and businesses, already evident in some of the ‘no’ states, will grow as they realize how much they're paying for their states' denials."