Straight answer: no hay multa federal. Since 2019 the government charges you nothing for being uninsured, and neither Florida nor Georgia has a state penalty. That said, the penalty was never the real reason to get covered, and anyone deciding on that basis is looking at the small problem.
1. The door closes until next November
This is what most people underestimate. If you let the enrollment period pass, you can't buy whenever you feel like it. You have to wait for the next one, with one exception: a life event that opens a special enrollment period.
And here's the trap: getting sick is not not one of those events. The day you need it you won't be able to buy it. The ones that do count are losing your coverage, moving states, getting married, divorcing, having a baby or no longer qualifying for Medicaid, among others. I go through them in special enrollment periods.
2. La factura no tiene tope
With a Marketplace plan there's an out-of-pocket maximum: once you hit that number, the plan pays 100% for the rest of the year. Uninsured, there is no ceiling at all.
To give you the order of magnitude: a three-day hospital stay runs around $30,000. An uncomplicated birth costs $3,000 to $8,000 out of your own pocket teniendo seguro; without it, the full bill. Appendicitis, a bad fracture or a car accident land in that category without warning.
3. You pay more for the same thing
Insurers negotiate prices with hospitals and doctors. Without a plan you don't have that negotiated rate: you get the list price, which is usually a good deal higher. Uninsured, you don't just pay everything, you pay everything at a higher price.
4. Pierdes lo preventivo
Marketplace plans cover check-ups, lab work and early detection with no copay. Uninsured, those visits get put off “until it's needed,” and by the time it's needed the treatment costs ten times as much.
The calculation that actually matters
Plenty of people don't enroll because they think they can't afford it, and a good share of them hasn't even looked with their income entered. In Georgia 89% of enrollees get government help, and in Florida over 95%. In Florida, one in three pays less than $10 a month.
Before deciding you can't afford it, it's worth seeing the real number. I explain how it's worked out in how much Obamacare costs.
And what if I really don't qualify?
It happens: income too high, immigration status, or because your job offers a plan that counts as affordable. In that case, going without anything is still the worst option.
There is coverage you can buy outside the Marketplace, any day of the year. It isn't full health insurance and it has fine print worth reading, but it covers exactly what can ruin you: private plans without a subsidy, hospital indemnity y accident insurance.
Before writing it off, look at the number
It's three questions and five minutes. If you qualify I'll tell you what you'd pay; if you don't, I'll tell you what options are left. Either way you come out knowing, and it costs you nothing.
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Sources
- IRS — the federal penalty for not having coverage has been $0 since tax year 2019.
- HealthCare.gov — special enrollment periods and out-of-pocket maximum.
- Neither Florida nor Georgia has established a state penalty for lack of coverage.
Please note: general insurance information, not legal or tax advice. The hospital cost figures are reference averages, not a quote.