Individuals & Families
The Individual Mandate
- The individual mandate is technically called an “Individual Shared Responsibility Fee,” which requires all eligible Americans to obtain health insurance or pay a Tax Penalty.
- The mandate includes you, your children and anyone else you claim as a dependent on your taxes.
- Mandate goes into effect January 1st, 2014.
Shared Responsibility Provision
- The Individual and Employer Mandate are part of the “Shared Responsibility Provision,” contained in the Affordable Care Act.
- The Provision states, “The federal government, state governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the US. Starting in 2014, the individual shared responsibility provision calls for each individual to have minimum essential health coverage for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return.”
Minimum Essential Coverage
- The Minimum Essential Coverage is the type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act.
- This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage.
- You also have new options in the Marketplace.
- The Marketplace is your State’s price comparison website for subsidized health insurance. In here, you are able to apply for coverage, compare your options and enroll.
- What if I can’t afford coverage?
- The Affordable Care Act provides two programs to help individuals afford coverage through the Marketplace:
- Premium tax credits.
- Cost-sharing reductions.
- Subsidies are aimed at people with incomes between 139% to 400% of the FPL (federal poverty level).
- *Current 139% FPL is $23,050 for a family of four and the 400% is $92,200.
- Families who make more than the current FPL will get considerably less cost assistance.
- Subsidies are given as refundable tax credits.
- Several groups are exempt from the requirement to obtain coverage or pay the penalty.
- These include:
- People whose health coverage may cost more than 8% of their household income.
- People with incomes too low for filing taxes.
- People with religious exemptions.
- Undocumented immigrants.
- People who are incarcerated.
- Members of Native American tribes.
- If you can afford health insurance and don’t have coverage by 2014, you will face a Tax Penalty.
- You are allowed a Coverage Gap of 3 consecutive months in a year and will be exempt from the fee for these months.
- The fee for not having insurance in 2014 is $95 per adult and $47.50 per child or 1% of your taxable income (up to $285 for a family), whichever is greater.
- The fee is based off of the number of months in a given year an individual is without “Minimal Essential Coverage” or an exemption.
- The IRS will collect the fee, if you choose not to pay it, by withholding the money you would get back after filing your income tax returns.
- Those who choose to pay the tax help subsidize the cost of health insurance purchased through the marketplace.
The Health Insurance Requirement
- The requirement to obtain health coverage is how Americans are able to enjoy the new benefits, rights and protections in their health care.
- These include:
- Coverage regardless of pre-existing conditions.
- No gender discrimination in costs.
- Preventive care with no out-of-pocket costs.
- And more.
- You can enroll:
- By Phone: 1-800-821-0604 , (219) 736 7800