Window closing for uninsured who want to avoid another fine next tax season

People who paid a penalty because they didn't buy health insurance last year are nearing the end of their options to get covered and avoid an even bigger penalty next tax season.

The special enrollment period - a window the U.S. Department of Health and Human Services opened for people who learned of the fine only when they filed their 2014 taxes - closes Thursday.

After that, current rules allow consumers to buy insurance from the marketplace only if they experience a life-changing event, such as marriage or loss of job-based coverage.

"You are taking a substantial risk remaining uninsured for another year," said Neil Deegan, Pennsylvania director of Enroll America, a nonprofit helping people enroll.

Though there are no hard numbers yet for how many people qualified for the special enrollment period, the U.S. Treasury Department estimated in January - before the current period was announced - that between 3 million and 6 million Americans would likely have to pay the penalty. The Hill, a newspaper that covers Congress and politics, reported last week that 68,000 people had signed up for insurance since this special enrollment period began March 15.

In Southeastern Pennsylvania, Enroll America and its partners had connected 1,700 people with navigators to buy insurance as of a few days ago. Deegan said many of them had not known they would be penalized for not going without coverage.

"There certainly is an information challenge here," he said. "Not everybody is aware."

Consumers who were uninsured last year had to pay a fine when they filed their 2014 tax returns: $95 for an adult and $47.50 for each child or one percent of household income, whichever is greater. The word to remember is greater.

To pay only the minimum penalty, a single person's income would have to be no more than $19,650 and a family's $29,800, according to the Kaiser Family Foundation. Nearly everyone making more paid one percent of household income, which usually was well above than the minimum.

In 2015 - for tax returns filed next April - the penalty increases to $325 for an adult and $162.50 for each child, or 2 percent of household income. For 2016, it jumps to $695 for an adult plus $347.50 per child, or 2.5 percent of household income, whichever is greater.

Not everyone who chose to go without insurance was surprised by the penalty. Some, Deegan said, figured they were healthy and would save money by paying the fine and skipping coverage. Others said even subsidized premiums were unaffordable.

And though some Pennsylvanians certainly refused for a third reason - they object to the Affordable Care Act - Deegan said he had not heard from them in his travels across the state.

Nearly 475,000 Pennsylvanians signed up for insurance during this year's main enrollment period (which ended Feb. 15) compared to 320,000 the year before. In New Jersey, 254,000 bought in this year vs. 162,000 the first year.

The local numbers show "great progress in terms of reducing the number of uninsured," Deegan said. "We are very pleased with the results, but we also know there is more work to do."

That work will be challenging because the people who remain uninsured are harder to reach and more skeptical of the Affordable Care Act, especially in rural areas. To reach them, Enroll America, which has had contact with almost 60,000 Pennsylvanians in the last 20 months, is shifting its ground game.

The organization will keep knocking on doors and calling to educate people about health insurance. But it will also work more closely with community leaders and groups across the commonwealth to spread the word.

It is likely getting a boost from the publicity surrounding the state's expansion of Medicaid on Jan. 1, a year later than New Jersey and most of the other states that opted in. Ironically, the controversy over how to expand it - former Gov. Tom Corbett began using federal Medicaid dollars to buy private market insurance with some state-specific guidelines and limitations, but Gov. Wolf is transitioning the program to what President Obama envisioned and what more than 20 states have adopted - may have added to the hoopla.

It undoubtedly confused a lot of people, as well.

Medicaid, which has no premiums and now covers legal residents earning up to 138 percent of the federal poverty level ($16,243 for a single-person household, $33,465 for four), does not have set enrollment periods. Sign-ups are continuing year-round (Pennsylvania: www.healthchoicespa.com; New Jersey: www.njfamilycare.org).