Health Care Options
Health Care Coverage Options for AmeriCorps Members
December 16, 2013
The content below is applicable to full-time AmeriCorps members serving in programs receiving AmeriCorps State and National grants. (It does not apply to members enrolled in AmeriCorps VISTA, AmeriCorps NCCC, Professional Corps or Education Award Only grant programs). If you have specific questions that aren't answered below, please follow up with your program manager. For AmeriCorps VISTA members, see the AmeriCorps VISTA Health Care Options or visit www.vistacampus.gov/healthcare.
Beginning in 2014, AmeriCorps members will have new options for quality, affordable health insurance made available by the Affordable Care Act (ACA).
Like all Americans, AmeriCorps members can now access comprehensive, affordable health insurance coverage through a variety of means. You can shop for plans in the Health Insurance Marketplaces at HealthCare.gov where you may be eligible for financial assistance; if you are under 26 you may be able to stay on your parent’s health insurance plan; or you may be able to obtain coverage through Medicaid, military health benefits, or Medicare. These health insurance options meet the new consumer protection standards under the Affordable Care Act.
Over the next year, AmeriCorps will be working to improve the quality of health care for its members and to provide insurance that meets the requirements of the ACA in the near future.
At this time, AmeriCorps programs must continue to offer a health plan to full-time AmeriCorps members, but these plans may not meet the standards of the Affordable Care Act. For example, these plans may exclude coverage of pre-existing conditions. If the plan does not meet the new consumer protection standards of the ACA, and you do not have other coverage, you may be required to pay a tax payment at the end of the year under the individual responsibility provision. Therefore, you should make sure to review your options carefully and make the choice that is right for you.
That is why we are reaching out to you directly to ensure you understand your health insurance options during your service as an AmeriCorps member. We are also communicating with leaders of your programs so they have a complete understanding of their options for providing health coverage to their members. They will be able to help answer your questions as well.
Overview: What Are Your Options?
It is important that you have information to help you learn what health care coverage is available to you so you can choose what works best for you. Your options might be different depending on your program or the state where you are serving. Please review the following information, and be sure to discuss this with your program. Whether you are already serving or just beginning your service, you should review this essential information.
- Family health care coverage: Under the Affordable Care Act, you can stay on your parent’s health insurance policy until your 26th birthday. You can even remain on your parent’s plan if you are married, not living with your parent(s), attending school, or not financially dependent on your parent(s). For more information about this option, please see: https://www.healthcare.gov/can-i-keep-my-child-on-my-insurance-until-age-26/. In addition, if you are married you may be able to get coverage on your spouse’s plan.
- Health care coverage purchased through the Health Insurance Marketplace: You may be eligible to obtain health care coverage through the Health Insurance Marketplaces where you are serving, and you may qualify for financial assistance to lower the costs of insurance. In some cases, insurance may be available with no monthly premium. Learn more at HealthCare.gov. In addition, your program may be able to help you pay for coverage you obtain through the Health Insurance Marketplace. If they do so, this assistance may be considered taxable income.
- Medicaid coverage: Under the Affordable Care Act, many states are expanding their Medicaid program. Depending on the amount of your stipend and where you serving, you may be eligible for Medicaid. For more information, please see: HealthCare.gov.
- Current health plan offered by your AmeriCorps Program: Currently serving full time AmeriCorps members already receive insurance through their programs. Your program may elect to continue to offer you the same plan they are offering you now, even if it does not meet all of the requirements under the ACA so long as it meets the requirements for AmeriCorps programs (you can find what is required for AmeriCorps programs on page 11 of the document found here: http://www.nationalservice.gov/sites/default/files/documents/FinalProvisions6-25-13.pdf).
- For example, your current plan may exclude coverage of pre-existing conditions. If your current AmeriCorps health plan does not meet the new consumer protection standards of the ACA and you do not have other coverage, you may be required to pay a tax payment at the end of the year under the individual responsibility provision. Before deciding to forego other coverage that may be available to you, you should review your options at HealthCare.gov because you may qualify for free or low cost health insurance. See the question-and-answer section below for more details.
Questions and Answers
What does the existing insurance cover?
- There is no one type of health plan covering all AmeriCorps members. AmeriCorps requires that programs provide a minimum level of coverage to their members. At a minimum, AmeriCorps programs are required to provide health plans that were short-term, limited duration (no more than 364 days) plans that include physician services for injury or illness, cover emergency room and hospital room and board, have an annual deductible of not more than $250, require members to pay no more than $1,000 out of pocket per year, and cover up to a maximum of $50,000 per event (the equivalent of an annual limit of $50,000). They are not required to cover preventive care or pre-existing conditions.
Will I have to pay a fine?
Answer updated on 3/10/2016 for the 2015 tax year:
Answer updated on 3/10/2016 for the 2015 tax year:
- The U.S. Department of Health and Human Services (HHS) is again exercising its authority to establish a hardship exemption for national service members who did not have minimum essential coverage (MEC) in 2015 (through December 31, 2015). This hardship exemption means that you will not be subject to the Individual Shared Responsibility payment for not maintaining MEC coverage in 2015.
- To request the hardship exemption, use the hardship exemption form available at http://www.healthcare.gov/exemptions and select reason #14. When prompted, fill in “AMERICORPS” as the reason.
- If you have already completed a hardship exemption form and were denied, please contact the healthcare marketplace to inquire about updating your hardship exemption form. We have worked with HHS to have them now approve those previously rejected exemption forms.
- If you have already filed your taxes and paid a penalty for not having MEC for the full year, you need to amend your tax return to reflect the fact that you now have an exemption.
Medicaid and the Marketplace
Will I qualify for free or reduced price health insurance?
- Under the Affordable Care Act, many states are expanding their Medicaid program. Eligibility depends on your state and is based on your income. Single individuals with incomes up to about $15,000 per year may qualify for Medicaid. For example, if your living allowance is below a certain income level and you do not have other income, you may be eligible for Medicaid. The income level varies by family size, other family members’ income, and other factors. To see if you qualify for Medicaid, please visit: https://www.healthcare.gov/do-i-qualify-for-medicaid/.
- You can also find a private health insurance plan through the Health Insurance Marketplace. Based on your income you can qualify for lower costs on your monthly premiums, and may even be able to find a plan with no monthly premium. Financial assistance is based on your income, and a single individual with incomes below about $46,000 per year may qualify.
What if I am in a state that didn’t expand its Medicaid program?
- You qualify for an exemption from the individual responsibility payment if you were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the ACA. You can keep your current health insurance without being subject to a fee.
Communicating with AmeriCorps Programs
What options did you give my program?
- As you know, AmeriCorps programs operate across the country. Therefore, we wanted to provide our grantees with options that could best meet their needs and those of members like you.
- Organizations that get funding for AmeriCorps members have been made aware of the options available to you. These options include organizations offering health insurance that provides the new consumer protections, staying on your parent’s or spouse’s health insurance plan, enrolling in a private health insurance plan in the Marketplace or Medicaid if you qualify, or continuing to offer the health plan they have used for many years (keeping in mind that coverage may not be considered minimum essential coverage).
- We are committed to working with your programs to make sure AmeriCorps members get quality, affordable health coverage.