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For people with bleeding disorders, the passage of the Affordable Care Act (ACA) has resulted in the removal of many barriers faced by this community to accessing the best health care. In 2014, more barriers were removed, including:

  • insurers will be prohibited from dropping or limiting coverage for people participating in clinical trials,
  • no more lifetime limits on insurance coverage for adults,
  • a ban of discrimination against anyone based on pre-existing conditions or gender, and
  • no more capping or canceling coverage just because a family member gets sick, suffers from a disease, or is in an accident.

ACA is providing people with health insurance options. But with change comes challenges. The first challenge is to fully understand the new health care insurance options.

  • Who qualifies for what?
  • What are employers required to do?
  • How does someone qualify for financial assistance in paying for health insurance?

Here is a rundown of some of the health insurance options available to you and your family.

ACA mandated on January 1, 2014, that every individual must have an acceptable form of health insurance health insurance (the individual mandate). Acceptable forms of health insurance include buying a health plan from the Health Insurance Marketplace or having employer sponsored insurance. Otherwise, you can have coverage under Medicaid, Children’s Health Insurance Program (CHIP), Medicare coverage, Tricare, and Veteran’s Health Program. To each rule there is an exception and it is no difference with the individual health insurance mandate. See below for more on the exceptions.

The information outlined in this section of the HFA web site describes some of the ways in which you and you family can satisfy the requirement to have insurance. Choosing the best option for you and your family is up to you.

Exceptions to the Mandate

There are exceptions to who is required to meet the individual mandate. These include:

  • people with a religious exemption,
  • US citizens not living in the States,
  • non-US citizens living in the States and any US possession,
  • people who are incarcerated,
  • members of Native American tribes,
  • people without coverage for less than three months,
  • people unable to afford coverage,
  • people whose income falls below the federal income tax filing threshold, and
  • people who receive a hardship waiver from the HHS secretary.

There is a penalty for failing to have health insurance

ACA is historic for many reasons, one of which is that it is the first time in US history that the federal government has ordered by law that US citizens purchase a commercial product. Because the individual mandate is just that, a mandate, ACA includes the absolute requirement for you and your family (specifically you dependents) to have health care insurance. Consequently, if you and your dependents do not have an acceptable form of health insurance and do not meet one of the exemptions listed above, you will be required to pay a penalty. The penalty is actually a tax. This penalty is taken directly out of your annual income tax return or added to the amount of income tax you owe.

The penalty for failing to have health insurance is the greater of a flat dollar amount assessed on a taxpayer and any dependents or a percentage of an individual’s or couple’s (if filing jointly) income. As people worked to find health insurance, there was a phasing in of flat dollar penalty amounts. For example, in 2014 the penalty was $95 per taxpayer, $325 in 2015, $695 in 2016, and adjusted annually for inflation from 2017 forward. The annual penalty amount is reduced by half for any dependents under age 18. The percentage of income penalty is calculated based on the amount of an individual’s household income that exceeds an applicable filing threshold each tax year. ACA includes caps on penalty amounts.

Perhaps a little confusing but not as scary has having a bleeding disorder and no health insurance!

Disclaimer. This website is a resource only and should be used for information purposes. Please work with your health care providers, insurance councilors, etc. to determine the best solution for you.


Assisting and Advocating for the Bleeding Disorders Community