A Q&A our company posted on the intranet.
I particularly like the last bullet under this heading: You may be exempt from the penalty for not maintaining acceptable health insurance coverage if you
Where Can I Obtain Coverage?
You have four options to obtain healthcare coverage:
• Employer Health Plan
• Spouse’s Employer Health Plan, if applicable
• Medicaid, CHIP, or another government sponsored plan
• The “Marketplace” (also known as the “Exchange”)
What is the Penalty if I Do Not Obtain Coverage?
The penalty for not obtaining acceptable health insurance coverage will be phased in over a three-year period. The amount of the penalty is the greater of two amounts—the flat dollar amount and a percentage of income.
• In 2014: the penalty is the greater of $95 per person or up to 1 percent
of income;
• In 2015: the penalty is the greater of $325 per person or up to 2 percent
of income;
• In 2016: the penalty is the greater of $695 per person or up to 2.5 percent
of income.
“Income” is defined as the taxpayer’s household income minus exemptions and standard deductions.
The penalty for children is ½ the amount of an adult.
Calculating the Penalty for Married Couple and Two Children – Example:
Sue and Bob are married and have two children, ages 3 and 6. They are applicable individuals (i.e., no exception applies), and they do not have health insurance for the 2014 tax year. Their combined household income (after exemptions and standard deductions) is $65,000. Their penalty under the flat dollar amount method would be $285 ($95 for Sue, $95 for Bob, and $47.50 for each child). Their penalty under the percentage of income method would be $650 ($65,000 × 1%). The penalty for Sue and Bob for 2014 is $650 (i.e., the greater of the flat dollar method and percentage of income method).
Who is Exempt?
Who is exempt from the individual mandate?
You may be exempt from the penalty for not maintaining acceptable health insurance coverage if you:
• Cannot afford coverage (that is, a required contribution for coverage
would cost more than 8 percent of your household income)
• Have income below the federal income tax filing threshold
• Are a member of certain Indian tribes
• Are given a hardship exemption by the Department of Health and Human
Services (HHS); you must file for and receive a hardship exemption
• Experience a gap in coverage for less than a continuous three-month
period (may only be used once per year)
• Qualify as a religious conscience objector
• Are a member of a health care sharing ministry
• Are incarcerated
• Are not a citizen, national or lawfully present in the United States
Financial Assistance
Is there financial assistance for obtaining coverage? Beginning in 2014, federal subsidies will be available to low-income individuals who obtain coverage through the Marketplace.
You may be eligible for a subsidy (tax credit) through the Marketplace if you:
• Generally have household income for the year between 138 percent and
400 percent of the federal poverty line (FPL) for the taxpayer’s family size
• May not be claimed as a tax dependent of another taxpayer
• File a joint return, if married
• Enroll in one or more qualified health plans through an Exchange
• Cannot be eligible for minimum essential coverage (such as coverage
under a government-sponsored program or an eligible employer-
sponsored plan)
Important…I
You are not eligible for a governmental subsidy if your employer provides a plan that meets “minimum value” and is determined to be “affordable” under the Affordable Care Act. Your employer will advise you through a Notice issued on or before Oct. 1 if your employer health plan meets these criteria.
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