Minimum essential coverage
To avoid the fee in 2014 you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following in 2014, you're considered covered and don't have to pay a penalty:
• Any Marketplace plan, or any individual insurance plan you already have
• Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
• Medicare
• Medicaid
• The Children's Health Insurance Program (CHIP)
• TRICARE (for veterans and veteran families)
• Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
• Peace Corps Volunteer plans
Other plans may also qualify. Ask your health coverage provider.
Who doesn't have to pay the fee
Uninsured people won't have to pay a fee if they:
• are uninsured for less than 3 months of the year
• are determined to have very low income and coverage is considered unaffordable
• are not required to file a tax return because their income is too low
• would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility
• are a member of a federally recognized Indian tribe
• participate in a health care sharing ministry (such as Samaritan Ministries)
• are a member of a recognized religious sect with religious objections to health insurance If you don't qualify for these situations, you can apply for an exemption asking not to pay a fee. You do this in the Marketplace.
What kinds of health insurance don't qualify as coverage?
Health plans that don't meet minimum essential coverage don't qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include:
• coverage only for vision care or dental care
• workers' compensation
• coverage only for a specific disease or condition
• plans that offer only discounts on medical services
{Daniel: The part below was written at the beginning of 2013}
Dear Friends, Happy New Year.
As most of you know, Obama won the election which means “Obama Care” will stand starting 2014. This means Americans are required to have health care by 2014. For those of us who are not independently wealthy, do not fall into medicare/Medicaid, or have free or employer provided health care, the step to comply with the law will be costly.
As a result of the changing laws, and a run in personally with 2 medical issues in 2012, I’ve done some research to find alternatives or a health insurance company that meets my needs.
I’m writing this letter to give you all the health care information I discovered that may help with some decisions that need to be made over the next year. I’ll start with the summary and for those who want the details, keep reading.
SUMMARY
I’ve chosen to go with a Christian health care sharing plan for multiple reasons (read the details below – it’s good). There are 3 Christian sharing plans that were written into the Obama care law eligible to meet the requirement for individuals to have health care. Out of the 3 organizations, I found Samaritan Ministries to be the best.
After reading the details, if you decide to go with Samaritan Ministries, PLEASE CONTACT ME FIRST. I’ll get credit for referring people to Samaritan Ministries. This is NOT the reason I went with this organization, but it would be great to get credit for referring people. Consider it a thanks for taking the time to write this email if it helps? {Daniel: contact me and I'll put her in touch with you.}
DETAILS
After going to the emergency room last year with a pain that I thought was appendicitis, and then getting an inner ear problem that left me dependent on others for about a month, I thought it was time to look into health insurance.
The more I looked the more disappointed I got. However, a friend told me about Samaritan Ministries (SM). After asking an onslaught of questions, I went to the Internet to do more research.
I’ll share a little about how it works (since you can go to SamaritanMinistries.org for more info) and then the main questions that were answered for me when comparing SM to regular insurance.
SM shares the cost of health care across its members. Depending on whether you are an individual or a family, your monthly share amount goes to a member who has a “publishable” health need. Your membership fee monthly does not change unless the board votes for this. The specifics for the board to vote are clearly stated on their website.
Not only do you help another believer in need, you have the opportunity to pray and write a note of encouragement. This means if you have a “publishable” health care need, you too will receive checks from many people to cover the need, along with notes of encouragement and prayer.
KEYS to SM for me.
- By sending your check directly to the person in need, you by pass the laws that say this is an insurance company. SM does NOT manage the health care funds. You are assured some one in the company is NOT absconding with the funds either.
- Because SM is NOT an insurance company, they are NOT required to cover some ethically questionable procedures and medicines.
- It’s Christian based and therefore applies Biblical principles to caring and helping others, especially with prayer.
- To be a member is affordable for many who otherwise could NOT afford health insurance.
- Price comparison per month with health insurance seemed the same or better with SM.
- You pick any hospital or doctor you want, covers emergencies overseas or anywhere in the USA.
- You are a “cash pay” which tends to bring bills lower, and for larger amounts, SM has a group that negotiates to bring the price down.
- It meets the Obama Care requirement to have health care.
- Had a tremendous reputation after reading multiple user reviews from various websites. I searched for a negative review and could NOT find one on SM. Yet I did find some issues with at least one other health care sharing organization.
- They have 2 programs, one up to $250,000 and a second additional program up to 1 million.
- The website is VERY CLEAR and does NOT seem to have hidden things like how member fees increase, etc. So I felt like I wasn’t wondering when and if an insurance company would raise my premiums. How many times have I heard people saying “my premiums are so expensive” and “my deductible are so high”? People DON’T use their health insurance because they fear increased premiums. What’s the point then?
- This is NOT an insurance company and is NOT regulated by certain laws.
- Pray, as it takes faith to know this is what God wants you to do.
- Not all needs are publishable (such as dental) but the do put the “unpublishable” needs sometimes in the newsletter for those who wish to give extra.
- Do your research on medicine as it may or may not be covered with SM.
- Preventive care is NOT covered.
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Health insurance (blue cross/shield)
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SM
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Higher cost monthly
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Low cost monthly
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Deductibles range and affect monthly cost
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First $300 per incident, responsibility of
person/family
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Unknown issues raise monthly costs
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Clear when/how monthly costs rise
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FINE PRINT what’s covered
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Clear list of what’s publishable
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Money motives based (shareholders)
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Christian based
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Government Regulated
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Regulated by a board / Biblical principles
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Choose needs to be covered
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Not all needs publishable
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Choose doctor/hospital depending on coverage.
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Choose your doctor/hospital
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Coverage limits
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Some items not publishable
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No one prays
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People pray
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DISCLAIMER
All choices made regarding your health care must be made based on your own personal circumstances. Please do your due diligence and research before deciding as fees, rules, and many other factors change from system to system and person to person. I will take NO responsibility for any choices made regarding health care decisions.
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