Health Care Exemption

[CKSINSURANCE]

Hi, if my client has 3 months gap in coverage for health insurance. Will she be penalized?

The healthcare website says short term gap is available for less than 3 month gap. so 3 months gap still will be penalized??

anybody?

 

[year2525]

No penalty for 3 month gap.

 

[TxOnline]

From IRS.gov:

22. What qualifies as a short coverage gap?
In general, a gap in coverage that lasts LESS than three months qualifies as a short coverage gap. If an individual has more than one short coverage gap during a year, the short coverage gap exemption only applies to the first gap.

I sure thought they taught us this at Certification School.
If not, it took me 30 seconds to look it up on Google & give you the exact wording from the horse's mouth.

Quick definition of LESS: Smaller than

 

[jstocking]

Even having insurance for a single day counts as having insurance for that month.

 

[RayNY]

Even having insurance for a single day counts as having insurance for that month.

Yes, but the issue is, you can't have insurance for a single day. Can't get an effective other than the 1st, can't get a term other than the last day of the prior month.

Lets say, you applied for coverage in March, with a 4/1 effective last year (within the OEP for 2014). If you paid attention to the enrollment figures, you'd know that most people waited till the last moment, and this applies to about a quarter of enrollees (about 2 million).

Jan/Feb/March not a single day of coverage. That's 3 months. They're getting a penalty (pro-rated for 3 months of non coverage) because they didn't have "less than" 3 months lapse.

Of course, a 3/1 effective and 11/31 term (even if it was retro) would also generate a penalty.

 

[jstocking]

Yes, but the issue is, you can't have insurance for a single day.

There are several situations that could arise that could give a person coverage for a partial month. Some examples I have come across are "children" ageing off their parent's plan when they turn 27, loss of employer coverage (not as common now as last year), and gaining/losing eligibility for Medicaid. For some reason our medicaid system in TN doesn't like to play nice with the healthcare.gov systems.

Otherwise, I agree with you. I just wanted to clarify that possibility could exist for the fringe cases and that was the language in the bill regarding end/start dates of coverage that were not month beginning/ending dates.

 

[RayNY]

There are several situations that could arise that could give a person coverage for a partial month. Some examples I have come across are "children" ageing off their parent's plan when they turn 27, loss of employer coverage (not as common now as last year), and gaining/losing eligibility for Medicaid. For some reason our medicaid system in TN doesn't like to play nice with the healthcare.gov systems.

Otherwise, I agree with you. I just wanted to clarify that possibility could exist for the fringe cases and that was the language in the bill regarding end/start dates of coverage that were not month beginning/ending dates.

You're 100% right, but I still haven't had any of those scenarios actually happen personally. NY is weird.

Age 26 is uncommon here, age 29 is a rider that covers to end of year they turn 30 (for free, or <1%, depending on carrier). Almost everyone that has "child" (weird to say about people older than me) that will age out just adds the age 29 rider. Groups term employees at the end of the month (current or retro) typically. I guess Medicaid could be mid month, but I've never had to deal with that.

 

[taterpeeler]

client would be fined.... 2 months is the limit

 

[yorkriver1]

Interesting that the open enrollment period would allow people to enroll one month beyond the date that would keep them from being penalized for not having coverage in 2015.