Affordable Care Act Individual Mandate

Affordable Care Act Individual Mandate

Do you have the minimum essential medical coverage?

In order to comply with section 1302 in the HRN, having essential coverage means that you have the following items covered in your plan:

  1. Ambulatory patient services.
  2. Emergency services.
  3. Hospitalization.
  4. Maternity and newborn care.
  5. Mental health and substance use disorder services, including behavioral health treatment.
  6. Prescription drugs.
  7. Rehabilitative and habilitative services and devices.
  8. Laboratory services.
  9. Preventive and wellness services and chronic disease management.
  10. Pediatric services, including oral and vision care.

Note: If you received your medical coverage from the healthcare.gov marketplace, you are covered on all the above.

What do you need to have for the health insurance marketplace?

  • Estimate your household income when you register.
  • Individuals under age 30 and people with hardship exemptions may buy catastrophic insurance.
  • You must choose either the bronze, silver, gold or platinum plans on the marketplace or get health insurance from a broker.


    Are you eligible for the premium tax credit?


    There are three criteria to meet:

  • Household income for the tax year is at least 100% but not more than 400% of the federal poverty line for the family size. (See below- Federal Poverty Line for 48 States and D.C):

  • $11,490 (100%) up to $45,960 (400%) for one individual.
  • $15,510 (100%) up to $62,040 (400%) for a family of two.
  • $23,550 (100%) up to $94,200 (400%) for a family of four.
  • The people must not be eligible to be dependents of another taxpayer.
  • Married people must file a joint return.

    What happens if I didn’t have insurance in 2014 or do not get insurance in 2015?
    You will be liable for the shared responsibility payment on your tax return. The penalty for not carrying insurance in 2014 is the greater of:

  • A flat dollar amount equal to $95 per adult in the household and $47.50 per child [limited to $285 (3X$95) --OR
  • 1% of household income over the tax return filing threshold.
    The payment will be capped for all taxpayers by the national average premium of a bronze level plan through the exchange. This amount is $204 per individual per month for 2014. For 2015, the flat dollar amount increases to $325 per adult and $162.50 per child (maximum $975) and the percentage of income increases to 2%. Much more information can be found at IRS.gov and especially at: http://www.irs.gov/uac/ACA-Individual-Shared-Responsibility-Provision-Ca....
    For 2015, the penalties increase to
  • A flat dollar amount equal to $325 per adult in the household and $162.50 per child --OR
  • 2% of household income over the tax return filing threshold.


    If you have any questions on how to save the most money with this penalty, please contact us today!