MONEY alternative assets

How Real Estate Can Boost Your Income in Retirement

REITs have been hot for a while. But there's still a corner of the market that has room for growth.

This is the third in a series of five articles looking at the most popular bond alternatives and the safest ways to use them to improve your income prospects when rates are low. Adapted from “Reaching for Yield” in the January/February issue of MONEY magazine.

High demand over the past year for the traditionally lofty yields on ­real estate investment trusts—the trusts are required to pay out 90% of their profits—has led to spectacular returns. Among the most popular REIT funds, for example, iShares Real Estate Fifty ETF and longtime MONEY 50 member Cohen & Steers Realty both gained more than 27% in 2014.

The rally has resulted in skimpy payouts for new investors: REIT index funds were yielding about 3% by year-end, far below their 7.5% historical average.

That’s led many analysts, such as Brad Thomas, editor of The Intelligent REIT Investor newsletter, to urge investors to be very picky about where they put new money. One pocket of opportunity now, he says, can be found in health care REITs, which specialize in leasing space to nursing homes, hospitals, and other medical facilities and will profit from the aging of the population. While their high P/Es may be off-putting—some are selling at more than 40 times earnings—a better way to assess REITs is to look at their funds from operations, or FFO. Whereas reported earnings treat depreciation on real estate holdings as an expense that lowers results, FFO adds depreciation back, which more accurately reflects the value of a trust’s property. Using that metric, health care ­REITs look relatively inexpensive, trading at 14.5 times FFO, compared with the industry’s average of 15.5.

Your best strategy: While you’re usually better off investing via mutual funds and ETFs, there are none now that substantially overweight health care trusts. That’s why ­Thomas and Morningstar senior REIT analyst Todd Lukasik instead favor individual health care REITs.

Both, for example, are fans of Ventas VENTAS VTR -0.6838% , which owns about 1,500 senior housing communities, skilled nursing facilities, and similar properties in the U.S. and Britain and was recently selling for 15 times FFO. Ventas raised its dividend 9% in December, giving it a yield around 4%. They also like HCP Inc. HCP, INC. HCP -0.5815% , which owns $22 billion worth of medical-related property. It is selling for 12 times FFO and yields 4.5%.

More in this series:
The Smart Way to Invest in Dividend Stocks
High-Yield Bonds: Where to Look for Quality Junk

TIME Congress

House GOP Pulls Anti-Abortion Bill on Roe v. Wade Anniversary

The House Republican leadership reversed course on plans to vote on an anti-abortion bill deemed too restrictive by many female lawmakers in its conference, exposing internal party divisions as activists mark the 43rd anniversary of Roe v. Wade with the March for Life.

The bill—the Pain Capable Unborn Child Protection Act—would ban abortions after the 20th week of a pregnancy. Even though a similar bill was passed two years ago, Republican lawmakers raised concerns that this bill included a controversial clause requiring that a woman had to report the rape to police before she could get an abortion. The House will now hold another symbolic vote on a different, old bill that bans taxpayer funding of abortions.

“The reporting requirements I think were problematic,” said Missouri Republican Rep. Vicky Hartzler, who met with House GOP Whip Steve Scalise to air out her concerns this week. “Statistics show that a lot of women who are raped do not report it.”

Hartzler said she hoped that the bill would come back up with altered language that could garner more support. It’s unclear whether or not the current bill could have passed.

The American Congress of Obstetricians and Gynecologists has opposed similar legislative proposals based on fetal pain as “not based on sound science.” The bill would be aimed at a minority of abortions, since 92 percent are performed within the first 13 weeks, according to the U.S. Centers for Disease Control and Prevention.

Conservatives supported the bill in its entirety and expect the leadership to bring it back in some form. Susan B. Anthony List, the March for Life Education and Defense Fund, and Concerned Women for America Legislative Action Committee officials said they were “disappointed” that there wouldn’t be a vote and would work with the House GOP leadership “to ensure the maximum number of votes” in the future. Conservative RedState activist Erick Erickson called Republican Rep. Renee Ellmers of North Carolina, a key figure in opposing the bill’s rape reporting language, the “GOP’s Abortion Barbie.”

“There was a lot of discussion in our retreat [last week] about this and some of the new people did not want to make this the first bill they voted on because the millennials have a little bit of a different take on it,” said Republican Rep. Ted Yoho of Florida. “But you will see it come back because the American people agree with it two to one. It’s a hideous practice. It needs to stop.”

The conservatives’ confidence that the bill will be resurrected would disappoint Democrats like Oregon Rep. Peter DeFazio, who said that now there is “some grain of hope that the Republican leadership is no longer going to be totally constrained by the wishes of their right-wing friends.”

Other Democrats said the abortion issue plays directly into their “war on women” narrative.

“It’s almost as though they’re creating the strategy for us, bringing up these bills,” New York Rep. Joseph Crowley, vice chairman of the House Democratic Caucus told the Hill.

“In contrast to talking about job creation and bigger paychecks, they’re putting a bill on the floor that undermines the health of of America’s women,” said House Minority Leader Nancy Pelosi in a press conference Thursday. “The bill is worse than the bill they pulled from the floor yesterday. That affected thousands of women, maybe, this affects millions of women. It not only affects their health, it affects the personal decisions of how they spend their own money on health insurance.”

Moderate Republicans such as Pennsylvania Rep. Charlie Dent agreed with Pelosi that the GOP should be talking about pocketbook issues instead.

“I would prefer that our party spend less time focusing on these very contentious social issues because that distracts us from broader economic messages where I think we have a much greater appeal to the larger public,” he said.

TIME Addiction

Typical American Smokers Burn Up at Least $1 Million During Their Lifetimes

Alaska smokers will spend over $2 million

American smokers spend at least $1 million dollars on cigarette-related expenditures over their lifetimes, according to a state-by-state analysis done by the financial consultancy company WalletHub.

The most expensive state for smokers is Alaska, where the habit costs over $2 million dollars on average. For a bargain, move to South Carolina, but that still comes in at nearly $1.1 million.

“I and most people really just think of the cost of cigarettes and taxes on the packs, but if you think about the healthcare costs, which can totally be avoided, healthcare insurance premiums, and in the workplace, bias against smokers, that can … add up,” said WalletHub spokeswoman Jill Gonzalez.

The study’s “average smoker” is someone who smokes one pack a day starting from the age of 18 (legal age to buy) and ending at 69 (the average age of death for a smoker).

So, if you’re looking for another excuse to quit, perhaps take a quick peak down millionaire’s row.

MONEY health

Smoking Can Cost You $1 Million to $2 Million in a Lifetime

smoking cigarette wrapped in money on ashtray
John Knil—Getty Images

Your pack-a-day habit isn't just destroying your lungs, but your bank account as well—more than you ever imagined.

According to the American Lung Association, tobacco kills nearly half a million Americans annually and costs the nation $333 billion per year in health-care expenses and lost productivity to boot. But it’s hard for the average person—specifically, the average smoker—to wrap one’s brain around such an enormous figure.

Coming to the rescue, timed to coincide with the CDC’s Tobacco Awareness Week, is a new state-by-state analysis from WalletHub detailing the lifelong financial costs of smoking for an individual. Because the average price of a pack of cigarettes varies widely around the country—$5.25 in Virginia, $8 in Michigan, $12.85 in New York—the lifetime outlay varies greatly from state to state as well. In all cases, though, the data gathered by WalletHub show that smoking is incredibly costly in addition to being potentially deadly.

The total cost per smoker is estimated at $1,097,690 in South Carolina—and it’s the least expensive state in the nation. A Kansas City Star headline noted that the “cost of smoking is cheap in Missouri … relatively,” as the state ranks as the eighth least expensive on WalletHub’s list, with the total cost for a lifetime of smoking running “only” $1,177,230. At the high end of the spectrum, there’s Rhode Island, Massachusetts, New York, and Connecticut, where the habit costs more than $1.9 million per person in a lifetime. Priciest of all is Alaska, which crosses the $2 million mark.

For a little perspective, federal data estimates that the cost of raising a child to age 18 is about $250,000—a big chunk of change, but only a small fraction of expenses reportedly incurred by smokers.

Right about now, the average smoker (or just the average reader with a healthy degree of skepticism) is probably thinking: hogwash. The process of coming up with such wild figures must involve a fair amount of smoke and mirrors, so to speak, right?

Let’s have a look at what WalletHub did, exactly. By far, the largest expense incorporated into the per-person total is the “tobacco cost per smoker,” measured at $786,346 in South Carolina, up to roughly $1.5 million in Alaska. WalletHub came up with that figure by multiplying the average price of a pack of cigarettes in each state by the number of days in 51 years. Fair enough. There are cheaper ways to go about buying cigarettes, like buying smokes by the case, but many people purchase by the pack.

What’s trickier is the way that WalletHub pumped up its tobacco cost estimates by calculating “the amount of return a person would have earned by instead investing that money in the stock market over the same period. We used the historical average market return rate for the S&P 500 minus the inflation rate during the same time period to reflect the return in present-value terms.” In other words, the assumption is that money not spent on cigarettes would have been dutifully and wisely invested over those same 51 years.

Similar assumptions have also been used in the now (mostly) discredited “latte factor,” which is the theory that holds that people can wind up with millions in the bank by cutting back on everyday expenses like a daily latte. Among other reasons, this line of thinking is questionable because people don’t necessarily invest money that they don’t spend on some product or service—they’re more likely to simply spend that money on something else.

WalletHub also includes other costs that many smokers never think about, factoring in added health care expenses (with state-by-state data from the CDC) and an 8% hit on income due to smoking, as determined in a study by the Federal Reserve Bank of Atlanta.

Add up all of these and a few other estimated expenses, and over the course of a half-century, the cost to the pack-a-day smoker runs $1 million to $2 million, according to WalletHub. Are the figures overblown? Well, perhaps a bit. There’s a good argument to be made that the data were construed to come up with totals that are as big and headline-worthy as possible. (After all, they got our attention.)

Nonetheless, even if the figures are on the inflated side, it’s an undeniable reality that the smoking habit costs big bucks over a lifetime. And oh yeah, it can make your lifetime a lot shorter. Let’s not forget that.

MONEY Benefits

Why Some Same-Sex Couples May Have to Marry Now

Same-sex wedding toppers on top of aspirin bottle
Sarina Finkelstein (photo illustration)—Getty Images (2)

With same-sex marriage legal in 35 states and D.C., a few employers are starting to roll back back health insurance and other benefits for domestic partners.

Until recently, same-sex couples could not legally marry. Now, some are finding they must wed if they want to keep their partner’s job-based health insurance and other benefits.

With same-sex marriage now legal in 35 states and the District of Columbia, some employers that formerly covered domestic partners say they will require marriage licenses for workers who want those perks.

“We’re bringing our benefits in line, making them consistent with what we do for everyone else,” said Ray McConville, a spokesman for Verizon, which notified non-union employees in July that domestic partners in states where same-sex marriage is legal must wed if they want to qualify for such benefits.

Employers making the changes say that since couples now have the legal right to marry, they no longer need to provide an alternative. Such rule changes could also apply to opposite-sex partners covered under domestic partner arrangements.

“The biggest question is: Will companies get rid of benefit programs for unmarried partners?” said Todd Solomon, a partner at McDermott Will & Emery in Chicago.

It is legal for employers to set eligibility requirements for the benefits they offer workers and their families — although some states, such as California, bar employers from excluding same-sex partners from benefits. But some benefit consultants and advocacy groups say there are legal, financial and other reasons why couples may not want to marry.

Requiring marriage licenses is “a little bossy” and feels like “it’s not a voluntary choice at that point,” said Jennifer Pizer, senior counsel at Lambda Legal, an organization advocating for gay, lesbian and transgender people.

About two-thirds of Fortune 500 companies offer domestic partner benefits, but only a minority is changing the rules to require tying the knot, said Deena Fidas, director of the workplace equality program at the advocacy group Human Rights Campaign.

Because same-sex marriage isn’t legal in all states, “many employers operating in multiple states … are retaining their partner benefit structures,” said Fidas.

Most companies making the changes, including Verizon, are doing so only in those states where same-sex couples can get married. And most give workers some time to do it.

“We gave them a year and a quarter to get married,” said Jim Redmond, spokesman for Excellus BlueCross BlueShield, which made the change for employees shortly after New York allowed same-sex unions.

Employers that offer domestic partner benefits — for both same-sex and opposite-sex partners — generally allow couples in committed relationships to qualify for health and other benefits upon providing documents, such as financial statements, wills, rental agreements or mortgages, proving they are responsible for each other financially.

Such benefits were particularly important before the federal health law barred insurers from rejecting people with pre-existing medical conditions.

“We had clients over the years who were living with HIV … the only health insurance they had, or had hope of getting was their partner’s, through a job,” said Daniel Bruner, director of legal services at the Whitman-Walker Health clinic in Washington D.C. “Now folks have more health insurance options.”

After the Supreme Court ruled the federal Defense of Marriage Act unconstitutional in 2013, the portion of the health insurance premium paid by employers on behalf of the same-sex spouse was no longer taxable under federal rules, although state taxes often applied where such marriages were not legal. When state marriage laws change, so do those tax rules.

In Arizona, Dena Sidmore and her wife, Cherilyn Walley are saving more than $300 a month in taxes on the health insurance from Walley’s state job, which covers them both. The savings came after the state’s same-sex marriage bar was thrown out by the courts in October.

They didn’t marry for benefits. They already had coverage under domestic partner requirements affecting Arizona state workers. They simply wanted to be married. Indeed, they tied the knot in September 2013, after driving all night to Santa Fe, N.M., where same-sex marriage was legal.

“It was lovely,” Sidmore said of the ceremony at the courthouse. But for her, the real change came when Arizona’s bar on same-sex marriage was overturned by the courts. She remembers thinking: “This is real. It’s not just a piece of paper.”

After the courts lifted the same-sex marriage ban, Arizona dropped its domestic partner program. State workers had until the end of last year to marry if they wanted to keep a partner on benefits.

Sidmore has no objection to employers requiring a marriage license for benefits because “spousal benefits require marriage,” although she thinks there should be exceptions for older residents who might face the loss of pensions or other financial complications if they remarry.

Benefit experts recommend that employers consider what it might mean for workers if benefits are linked to marital status — especially those that operate in states where same-sex marriage is not legal.

While some couples, like Sidmore and Walley, may be willing to travel to tie the knot, others may not want to, or may be unable to afford it. Additionally, some workers may fear if they marry, then move or get transferred to a state where same-sex marriage is barred, they would face discrimination.

Joe Incorvati, a managing director at KPMG in New Jersey, married his partner, Chuck, in 2013 when it became an option. “We’d been together for 38 years, so it just seemed natural,” he said.

KPMG offers domestic partner benefits and does not require employees to be married for eligibility. While he’s comfortable in New Jersey, Incorvati said it could be a problem if his company wanted to transfer him to a state where same sex marriage is not legal.

Even though his work benefits would remain the same, “Would I have the same rights as in New Jersey?” Incorvati asked. “The answer may be no.”

Kaiser Health News (KHN) is a nonprofit national health policy news service.

TIME Health Care

Administrator Who Oversaw Roll-Out of Obama’s Health Care Law Steps Down

Obamacare Marilyn Tavenner
From left, Marilyn Tavenner, Administrator of CMS, Department of Health and Human Services, Jonathan Gruber of MIT, and Ari Goldman, testify at a House Oversight and Government Reform Committee hearing titled "Examining Obamacare Transparency Failures," in Washington on Dec. 09, 2014. Tom Williams—CQ-Roll Call/Getty Images

Marilyn Tavenner says she's leaving with "sadness and mixed emotions"

(WASHINGTON) — Medicare chief Marilyn Tavenner — who oversaw the rocky rollout of the president’s health care law — says she’s stepping down at the end of February.

In an email Friday to staff at the Centers for Medicare and Medicaid Services, Tavenner says she’s leaving with “sadness and mixed emotions.”

Tavenner survived the 2013 technology meltdown of HealthCare.gov, but was embarrassed last fall when she testified to Congress that 7.3 million people were enrolled for coverage. That turned out to be an overcount that exaggerated the total by about 400,000.

Calling Tavenner “one of our most esteemed and accomplished colleagues,” Health and Human Services Secrerary Sylvia M. Burwell said the decision to leave was Tavenner’s.

Principal deputy administrator Andy Slavitt will take over as acting administrator.

TIME California

Brittany Maynard’s Family Fulfills Sacred Promise to Her

Brittany Maynard Death with Dignity
This undated file photo provided by the Maynard family shows Brittany Maynard, a 29-year-old terminally ill woman who plans to take her own life under Oregon’s death with dignity law. AP

Maynard's last wish was for California to pass death-with-dignity legislation

The text came from the bedroom above. “Are you coming up?” asked his brother, Dan Diaz.

Adrian Diaz felt nervous about heading to the second story where his sister-in-law, Brittany Maynard, 29, was about to purposefully swallow a prescribed, lethal medication. They had grown close since her diagnosis of terminal brain cancer.

He climbed the stairs on Nov. 1 in the Portland, Oregon home Maynard had rented with her husband, Dan, so she could access that state’s Death With Dignity law. Adrian saw Brittany in her bed. She immediately rose and stepped to him. She hugged him, said she loved him, then gave the Bay Area lobbyist a solemn task…

Read the rest of the story from our partners at NBC News

MONEY Health Care

The Most and Least Expensive Places in the U.S. for Health Insurance

South Franklin Street with Mount Roberts tram car passing overhead in Downtown Juneau, Alaska.
Buy your own health insurance? You're paying top dollar if you live in Alaska. Alamy

A survey of health insurance premiums on the exchanges finds that costs tend to be the highest in rural areas with less competition.

In health insurance prices, as in the weather, Alaska and the Sun Belt are extremes. This year Alaska is the most expensive health insurance market for people who do not get coverage through their employers, while Phoenix, Albuquerque, N.M., and Tucson, Ariz., are among the very cheapest.

In this second year of the insurance marketplaces created by the federal health law, the most expensive premiums are in rural spots around the nation: Wyoming, rural Nevada, patches of inland California and the southernmost county in Mississippi, according to an analysis by the Kaiser Family Foundation, which has compiled premium prices from around the country. (KHN is an editorially independent program of the foundation.)

The most and least expensive regions are determined by the monthly premium for the least expensive “silver” level plan, which is the type most consumers buy and covers on average 70% of medical expenses. Premiums in the priciest areas are triple those in the least expensive areas.

Along with the three southwestern cities, the places with the lowest premiums include Louisville, Ky., Pittsburgh, and western Pennsylvania, Knoxville and Memphis, Tenn., and Minneapolis-St. Paul and many of its suburbs, the analysis found.

Starting this month, the cheapest silver plan for a 40-year-old in Alaska costs $488 a month. (Not everyone will have to pay that much because the health law subsidizes premiums for low-and moderate-income people.) A 40-year-old Phoenix resident could pay as little as $166 for the same level plan.

That three-fold spread is similar to the gap between last year’s most expensive area — in the Colorado mountain resort region, where 40-year-olds paid $483—and the least expensive, the Minneapolis-St. Paul metro area, where they paid $154.

Minneapolis remained one of the cheapest areas in the region, although the lowest silver premium rose to $181 after the insurer that offered the cheapest plan last year pulled out of the market. Premiums in four Colorado counties around Aspen and Vail plummeted this year after state insurance regulators lumped them in with other counties in order to bring rates down.

Cynthia Cox, a researcher at the Kaiser foundation, said the number of insurers in a region was a notable similarity among both the most and least expensive areas. “In the most expensive areas only one or two are participating,” she said. “In the least expensive areas there tends to be five or more insurers competing.” She said that other factors, such as whether insurers need state approval for their premiums and the underlying health of the population, may play a role as well in premiums.

The national median premium for a 40-year-old is $269, according to the foundation’s analysis.

Alaska’s lowest silver premium rose 28% from last year, ratcheting it up from 10th place last year to the nation’s highest. Only two insurers are offering plans in the state, the same number as last year, but the limited competition is just one reason Alaska’s prices are so high, researchers said. The state has a very high cost of living, which drives up rents and salaries of medical professionals, and insurers said patients racked up high costs last year.

Ceci Connolly, director of PwC’s Health Research Institute, noted that the long distances between providers and patients also added to the costs. Restraining costs in rural areas, she said, “continues to be a challenge” around the country. One reason is that there tend to be fewer doctors and hospitals, so those that are there have more power to dictate higher prices, since insurers have nowhere else to turn.

By contrast, in Maricopa County, Phoenix’s home, the lowest silver premium price dropped 15% from last year, when Phoenix did not rank among the lowest areas. A dozen insurers are offering silver plans. “Phoenix, during the boom, attracted a lot of providers so it’s a very robust, competitive market,” said Allen Gjersvig, an executive at the Arizona Alliance for Community Health Centers, which is helping people enroll in the marketplaces.

The cheapest silver plan in Phoenix comes from Meritus, a nonprofit insurance cooperative. The plan is an HMO that provides care through Maricopa Integrated Health System, a safety net system that is experienced in managing care for Medicaid patients. Meritus’ chief executive, Tom Zumtobel, said they brought that plan’s premium down from 2014. The insurer and the health system meet regularly to figure out how to treat complicated cases in the most efficient manner. “We’re working together to get the best outcome,” Zumtobel said.

Katherine Hempstead, who oversees the Robert Wood Johnson Foundation’s research on health insurance prices, found no significant differences in the designs of the plans that would explain their premiums. “In most of the plans – cheap or expensive – there seemed to be a high deductible and fairly similar cost-sharing,” she said.

Highest and Lowest Premiums

Here are the 10 most and least expensive regions in the country–with the counties listed in parenthesis–based on premium prices for the lowest-cost silver plan. Regions are counties that share the same price for the same lowest-cost-plan and are either geographically contiguous or are part of the same rating area created by the state.

Premiums are listed for 40-year-olds; and for most states the difference in prices stays the same for people of any age. Vermont and two upstate New York area—Ithaca and Plattsburgh—also are among the 10 most expensive places, although those states do not let insurers adjust premiums based on the consumer’s age, making comparisons inexact. Older residents in those states will end up getting better deals than in most places, while younger ones tend to pay more.

10 Highest Premiums
Region Monthly premium
Alaska (entire state) $488
Ithaca, NY (Tompkins) $459
Bay St. Louis, Mississippi (Hancock) $456
Plattsburgh, NY (Clinton) $446
Rural Wyoming (Albany, Big Horn, Campbell, Carbon, Converse, Crook, Fremont, Goshen, Hot Springs, Johnson, Lincoln, Niobrara, Park, Platte, Sheridan, Sublette, Sweetwater, Teton, Uinta, Washakie, and Weston) $440
Vermont (entire state) $428
Rural Nevada (Churchill, Elko, Eureka, Humboldt, Lander, Mineral, Pershing, and White Pine) $418
Casper, Wyoming (Natrona) $412
Inland California (Imperial, Inyo, and Mono) $410
Cheyenne, Wyoming (Laramie) $401
10 Lowest Premiums
Region Monthly premium
Phoenix, Ariz. (Maricopa) $166
Albuquerque, N.M. (Bernalillo, Sandoval, Torrance, and Valencia) $167
Louisville, Ky. (Bullitt, Jefferson, Oldham, and Shelby) $167
Tucson, Ariz. (Pima and Santa Cruz) $170
Pittsburgh, Pa. (Allegheny and Erie) $170
Western Pennsylvania (Beaver, Butler, Washington, Westmoreland, Armstrong, Crawford, Fayette, Greene, Indiana, Lawrence, McKean, Mercer, and Warren) $179
Knoxville and Eastern Tennessee (Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Roane, Scott, Sevier, and Union) $181
Minneapolis-St. Paul (Anoka, Benton, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne, Stearns, Washington, and Wright) $181
Memphis and suburbs (Fayette, Haywood, Lauderdale, Shelby, and Tipton) $184
North of Minneapolis (Chisago and Isanti) $189

Kaiser Health News (KHN) is a nonprofit national health policy news service.

MONEY Taxes

How Obamacare Could Make Tax Filing Trickier This Year

Affordable Care Act health insurance marketplace navigator Herb Shook pulls up information on his computer to help someone re-enroll in an Affordable Care Act health insurance plan Friday, Nov. 14, 2014, in Houston.
If you got a health insurance subsidy via the online marketplace, you may have more work to do on your tax return. David J. Phillip—AP

For the first time, you'll need to show that you had health insurance last year. For some, that means more paperwork.

In addition to the normal thrills and chills of the income tax filing season, this year consumers will have the added excitement of figuring out how the health law figures in their 2014 taxes.

The good news is that for most people the only change to their normal tax filing routine will be to check the box on their Form 1040 that says they had health insurance all year.

“Someone who had employer-based coverage or Medicaid or Medicare, that’s all they have to do,” says Tricia Brooks, a senior fellow at Georgetown University’s Center for Children and Families.

The law requires people to have “minimum essential coverage,” but most types of insurance qualify.

But for others, here are several situations to keep in mind.

If you were uninsured for some or all of the year

If you had health insurance for only part of 2014 or didn’t have coverage at all, it’s a bit more complicated. In that case, you’ll have to file Form 8965, which allows you to claim an exemption from the requirement to have insurance or calculate your penalty for the months that you weren’t covered.

On page 2 of the instructions for Form 8965 you’ll see a lengthy list of the coverage exemptions for which you may qualify. If your income is below the filing threshold ($10,150 for an individual in 2014), for example, you’re exempt. Likewise if coverage was unaffordable because it would have cost more than 8% of your household income, or you experienced a hardship that prevented you from buying a marketplace plan, or you had a short coverage gap of less than three consecutive months. These are just some of the circumstances that would allow you to avoid the penalty.

In addition, you don’t have to pay a penalty if you live in a state that didn’t expand Medicaid to adults with incomes up to 138% of the federal poverty level $16,104.60 for an individual in 2013) and your income falls below that level.

Some of the exemptions have to be granted by the health insurance marketplace, but many can be claimed right on your tax return. The tax form instructions spell out where to claim each type of exemption.

If you do have to go to the marketplace to get an exemption, be aware that it may take two weeks or more to process the application. Act promptly if you want to avoid bumping up against the April 15 filing deadline, says Timothy Jost, a law professor at Washington and Lee University who is an expert on the health law.

If you don’t qualify for a coverage exemption

If none of the exemptions apply to you, you’ll owe a penalty of either $95 or 1% of your income above the tax filing threshold, whichever is greater. The penalty will be prorated if you had coverage for at least part of the year. The amount of the penalty is capped at the national average premium for a bronze level plan, or $2,448 for an individual in 2014.

The instructions for Form 8965 include a worksheet to calculate the amount of your penalty.

If you received a premium tax credit for a marketplace plan

Under the health law, people with incomes between 100% and 400% of the federal poverty level ($11,490 to $45,960 for an individual in 2013) could qualify for premium tax credits for 2014 coverage bought on the exchanges. If consumers wished, the tax credit was payable in advance directly to the insurer. Many chose that option.

The marketplace determined the amount of premium tax credit people were eligible for based on their estimated income for 2014. At tax time those estimates will be reconciled against actual income. People whose actual income was lower than they estimated may have received too little in advance premium tax credits. They can claim the amount they’re owed as a tax refund.

People whose income was higher than estimated and received too much in advance premium tax credits will generally have to pay some or all of it back. The amount that must be repaid is capped based on a sliding income scale, but people whose income is 400% of poverty or higher will have to pay the entire amount of any tax credit back.

If you bought a plan on the marketplace, you’ll receive a Form 1095-A from your state marketplace by Jan. 31 that spells out how much your insurer received in advance premium tax credits. You’ll use that information to complete Form 8962 to reconcile how much you received against the amount you should have received.

Assuming the information on the form is correct, “It should be easy to reconcile,” says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. Tax software programs and tax preparers should know how to make the calculations, she said.

In addition to using commercial tax software or hiring tax preparer, many lower income consumers and seniors can get free tax preparation assistance through the IRS Volunteer Income Tax Assistance (VITA) and the Tax Counseling for the Elderly (TCE) programs.

Despite resources to help consumers, this first filing season is likely to be bumpy, particularly for people who have complicated family situations or who receive inaccurate information from the marketplace.

“There is just so much confusion out there,” says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.). “People are going to see these forms and not have any idea what they’re supposed to do with them.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME Health Care

Clinic Loses Accreditation After Joan Rivers’ Death

Joan Rivers-Death Investigation
Yorkville Endoscopy seen in New York, Sept. 5, 2014. Tina Fineberg—AP

The clinic has been cited for multiple errors in its care of the late comedian

The New York clinic where TV personality Joan Rivers underwent vocal cord surgery, before her sudden deterioration and death, will lose its federal accreditation at the end of the month.

As of Jan. 31, Yorkville Endoscopy will no longer receive Federal funds for services given to Medicare and Medicaid beneficiaries, the Huffington Post reports.

Earlier this past year, the New York State Department of Health determined that the clinic made multiple errors during Rivers’ care. Rivers died on Sept. 4 after suffering brain damage from lack of oxygen after she quit breathing during surgery only a few days earlier.

An employee of the clinic also reportedly took a photo of Rivers during the surgery.

The clinic released a statement, saying: “We are continuing to work with all regulatory bodies. We intend to communicate with CMS and appropriate authorities to have the decision reversed. Yorkville continues to be a licensed facility and perform procedures while cooperating with the regulatory process.”

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