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The 'Opt Out' nation: Why uninsured Americans decided to pass on Obamacare

When the federal health insurance marketplace officially debuted this time last year, Marta Hardy, 60, felt just one emotion: relief.

At the time, Hardy, who lives in Lakeland, Ga., had gone nearly four years without insurance. She had a decent-paying job working full-time at a small manufacturing plant, but the company didn’t offer health plans. Her husband was already retired and could take advantage of Medicare. That left Hardy, who was recently diagnosed with thyroid disease and takes medication for high blood pressure, entering her 60s with no safety net.

“I was excited to finally have an opportunity to have insurance,” she says. “Then I checked [the marketplace] and I found that the lowest tier Bronze plan was going to run me $725 per month, plus a $6,300 annual deductible. That is a house payment or two car payments for me.”

Hardy decided not to sign up. Come tax time, she, like most people who decided to forgo insurance in 2014, will have to pay for that decision. The penalty this year is 1% of gross annual income or $95 per adult (whichever is greater), plus $47.50 per child. There are a few exemptions to this rule, including people who earn too little to file federal taxes (less than $20,000 for families and less than $10,000 for individuals) and people who spend more than 8% of their income on health insurance.  

But for Hardy, deciding between a penalty or health coverage was a simple matter of math. Signing up for a plan would have been much costlier than taking the penalty and continuing to pay out of pocket.  

“I go to the doctor several times every year and still does not add up to what my insurance premium would have been under Obamacare,” she says. “I’m glad there’s something out there for people who can’t get insured, but there are people who are working and paying their bills and trying to follow the rules and it’s not even within our reach.”

The ‘opt-out’ nation

Marketplace Eligibility & Enrollment Numbers by State | FindTheBest

More than 8 million Americans purchased new health plans in 2014, but there are still an estimated 41 million American adults left uninsured in the U.S., according to the CDC

For some consumers like Hardy, it’s not for lack of desire. More than 30% of uninsured Americans said cost was the biggest barrier for purchasing coverage, according to a Kaiser Family Foundation survey published last year. Another 30% blamed their lack of coverage on job loss. Only 1.5% said they didn’t have coverage because they didn’t need it.

Federal tax subsidies can dull the sting of an otherwise expensive plan. Per Kaiser, 17 million Americans who were either uninsured or purchased health insurance on their own were eligible for subsidies this year

Marsha Danley, 56, was among those who earned too much to qualify for a subsidy. It’s been more than a decade since Danley last had a insurance. After losing her job at a tech company during the dot-com crash, she worked for a string of small employers that didn’t offer benefits.

The Napa, Calif., accountant earns $68,000 a year (well above the $45,000 individual income threshold to qualify for tax subsidies) and was quoted $500 a month for a benchmark Silver plan, which came with a $5,000 annual deductible.

If she were debt-free, the $500 monthly premium might be manageable. But when her mother became ill a few years ago, her home healthcare bills fell into Danley’s lap, leaving her with nearly $20,000 worth of debt to manage on her own.

“Taking a hit on my tax refund is a lot cheaper than paying $6,000 a year for a plan and another $5,000 for a deductible,” she says. “That’s a total waste of money for me. That can be better put to paying off my debt.”

Danley, who does her own taxes, is preparing to factor in the 1% penalty already.

“I think it’s great that they make it where everybody can get insurance, but to say that if you don’t get it I’m going to tax you, that’s not right,” she says.

What to expect at tax time

So what happens if you didn’t have health insurance this year? When tax season rolls around next year, be prepared to face a penalty. Once you know what your final income will be for 2014, you should be able to calculate the penalty amount on your own. But people who have more complicated tax situations might want to sit down with a tax pro soon to figure out what they’re up against.

If you qualify for an exemption from the penalty, you’ll have to  fill out Form 8965 when you file taxes. Check out a preview of what that form will look like here, but the final version of the form hasn’t yet been issued by the IRS, says Kristin Esposito, a CPA and a tax staff member with the American Institute of CPAs.

Overall, the process should be simple to complete. But considering the glitches that plagued the marketplace’s rollout last year, it might be best to handle your taxes a bit earlier than usual in 2015.

“Whenever there’s something new like this, there are going to be some bumps in the road,” Esposito says.

Months before tax-filing season, consumers without insurance now will again have to decide whether to sign up for coverage next year. Open enrollment period for the federal marketplace and state-run exchanges begins Nov. 15.

The threat of a 1% tax penalty may not have been enough to push people over the fence this time around, but the penalties will only increase – up to 2% of income or $325 per adult in 2015, and 2.5% of income or $695 per adult in 2016.

At the same time, the cost of the benchmark silver plan is predicted to drop by 0.8% next year, which might make it harder for some to argue against signing up.

“Folks need to reevaluate very shortly if they want coverage for 2015, because even if they didn’t owe a penalty for 2014, that doesn’t mean they wouldn’t owe one for 2015 and the penalty could be much steeper,” Esposito says.

Are you planning to change your Obamacare plan or sign up for the first time this year? We'd like to hear from you: yfmoneymailbag@yahoo.com.

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Read more in our Obamacare series:

The Obamacare marketplace one year later: How you’re faring

How to see through opaque health care costs

Obamacare navigators are facing a tough road this year