Individual Health Insurance:
Obamacare: The Affordable Care Act & the NY State Exchange

Happy family lying down in the gardenNY State of Health is a new Heath Plan Marketplace. Individuals and Families looking for low cost, quality health insurance options can now use it to buy affordable plans. Depending on someone’s “Modified Adjusted Gross Income” these individuals or Families may also qualify for assistance in paying the premiums.

At PBT we help individuals and families sort through the available plan types. We explain the benefits and plans in plain English so you can make the right decision. If you qualify for financial assistance (subsidy) we help make sure you get as much as you deserve.

Children who are eligible may also qualify for Child Health Plus for little or no cost.
Smiling doctor working with a tablet computer

Calculating Modified Adjusted Gross Income “MAGI”


If you don’t have Health Insurance: How much you’ll pay

If you can afford health insurance but choose not to buy it, you must pay a fee called the individual shared responsibility payment. (The fee is often called the “penalty”, “fine”, or individual mandate.”)

  • You owe the fee for any month you , your spouse, or your tax dependents don’t have qualifying health coverage.
  • You pay the fee when you file your federal tax return for the year you don’t have coverage.

The fee for not having health insurance in 2016 & 2017
The fee is calculated 2 different ways, either as a percentage of your household income or per person. Whichever is higher.
Percentage of income is 2.5% of household income and or $695 per adult and $347.5 per child under 18 to a maximum of $2,085.