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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

July 3, 2014 at 1:07 PM

Same-sex newlyweds eligible for health insurance

Ad for Washington's insurance exchange.

Ad for Washington’s insurance exchange.

Gay and lesbian couples whose domestic partnerships automatically became marriages on Monday are eligible for a special health-insurance enrollment period.

The default marriages count as a “qualifying life event” that allows Washington residents to buy insurance on the individual market at a time when enrollment is closed to most people.

Other qualifying events include conventional marriages of gay or straight couples, having a baby or adopting, moving to an area with different insurance options, turning 26 and no longer qualifying for insurance through a parent, or losing insurance due to divorce, graduating college or COBRA coverage ending.

Residents generally have 60 days from the date of the qualifying event to buy insurance through the state’s exchange, called Washington Healthplanfinder, or outside of the exchange through a broker or directly from an insurance company. Couples now married due to the change in their domestic partnership status have until Aug. 28 to enroll (more information on enrollment can be found here on the state’s exchange website).

“The summer months are traditionally the most popular time of year for Washingtonians to get married,” said Richard Onizuka, chief executive officer of the state’s insurance exchange, in a news release.  “Any newlywed same-sex or heterosexual couple can take advantage of the opportunity to find free or low-cost coverage outside of the standard open enrollment period.”

Roughly 3,600 same-sex domestic partnerships in Washington converted to marriages June 30. The conversions apply to couples who are under age 62 and whose partnership was registered with the state. The change in marital status is thanks to the state’s same-sex marriage law, which voters passed in 2012.

Additionally, American Indians/Alaskan Natives can sign up for insurance anytime and Medicaid enrollment is open year-round and applies to people with an income below 138 percent of the federal poverty level (that’s approximately $16,000 for an individual).

Depending on someone’s income, insurance purchased through the state’s exchange may be eligible for tax breaks that reduce the cost of premiums and other expenses. Individual insurance bought outside of the exchange does not offer such discounts.

Most people are required to have insurance through work or an individual plan or have coverage through a federal program such as Medicare or Medicaid. With some exemptions, uninsured residents face a penalty under the Affordable Care Act’s Individual Shared Responsibility Provision.

This year the uninsured will be dinged one of two ways: either $95 per adult and $47.50 per child (up to $285 per family), or as 1 percent of adjusted household income — whichever is larger. Next year the penalties spike to $325 per adult and  $162.50 per child (up to $975 per family), or 2 percent of household income, again whichever is more. Experts say most people will wind up paying the income-based penalty, which will be calculated when people file their federal taxes for 2014.

The next open-enrollment window for all residents starts Nov. 15 and provides coverage beginning in 2015.

Comments | Topics: Affordable Care Act, enrollment, health insurance


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