Beginning in 2014, the Affordable Care Act includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. Some individuals will be exempt from the mandate or the penalty, while others may be given financial assistance to help them pay for the cost of health insurance.
What type of coverage satisfies the individual mandate?
“Minimum essential coverage”
What is minimum essential coverage?
Minimum essential coverage is defined as:
Minimum essential coverage does not include health insurance coverage consisting of excepted
benefits, such as dental-only coverage.
How does “Minimum Essential Coverage” differ from “Essential Health Benefits”?
Essential health benefits are required to be offered by certain plans starting in 2014 as a component of the essential health benefit package. They are also the benefits that are subject to the annual and lifetime dollar limit requirements.
This is different than minimum essential coverage, which refers to the coverage needed to avoid the individual mandate penalty. Coverage does not have to include essential benefits to be minimum essential coverage.
What is the penalty for noncompliance?
The penalty is the greater of:
There is a family cap on the flat dollar amount (but not the percentage of income test) of 300 percent, and the overall penalty is capped at the national average premium of a bronze level plan purchases through an exchange. For individuals under 18 years old, the applicable per person penalty is one-half of the amounts listed above.
Beginning in 2017, the penalties will be increased by the cost-of-living adjustment.
Who will be exempt from the mandate?
Individuals who have a religious exemption, those not lawfully present in the United States, and incarcerated individuals are exempt from the minimum essential coverage requirement.
Are there other exceptions to when the penalty may apply?
Yes. A penalty will not be assessed on individuals who:
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