The Procrastinator's Guide to Health Reform’s Individual Mandate

Legal stuff

Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues. The following is a brief overview only (as of September 2013). Photo Credits: BigStock Photo

What is the individual mandate?

A provision of health reform’s

Requires most people to have a minimum amount of health

insurance coverage

The individual mandate

3.5 Million +

Any exceptions?

3.5 Million +

YES – THERE ARE A FEW EXCEPTIONS

Exceptions

If you don’t have to file a tax return because you don’t make enough money*

*According to the IRS guidelines

You can’t afford to buy insurance

NO, THAT’S NOT UP TO YOU

The IRS defines that as coverage that costs more than 8% of your household income

You can’t afford to buy insurance

Indian Tribes *

Certain religious sects*

People who are in prison

Undocumented immigrants

*Federally-recognized

Other exceptions

Where can you buy insurance?

3.5 Million +

Your employer (if they offer it)

3.5 Million +

Your employer (if they offer it)

Your state’s health insurance marketplace

(Exchange)

3.5 Million +

A government program

(if you qualify)

Other plans

3.5 Million +

A government program

(if you qualify)

Directly from an insurance company

or broker

Other plans

3.5 Million +

What if you still can’t afford it?

If insurance costs less than 8% of your

household income

3.5 Million +

What if you still can’t afford it?

If insurance costs less than 8% of your

household income

BUT, YOU STILL CANNOT AFFORD IT – YOU MAY BE ELIGIBLE FOR HELP (A SUBSIDY) PAYING

YOUR PREMIUM

Who is eligible for help?

Middle & low income individuals may be eligible

Who is eligible for help?

2013 ESTIMATES

Individuals earning $45,960 (or less)

A family of four $94,200 (or less)

ESTIMATES BY FAMILYUSA

What if you don’t purchase insurance?

There is a tax penalty

THE FLAT DOLLAR AMOUNT

$95 $47.50 $325

$162.50 $695

$347.50

PER ADULT PER CHILD

2014 2015 2016

You pay the higher of

THE FLAT DOLLAR AMOUNT

$95 $47.50 $325

$162.50 $695

$347.50

PER ADULT PER CHILD

2014 2015 2016

You pay the higher of

OR THE % OF FAMILY INCOME

$95 $47.50 $325

$162.50 $695

$347.50

PER ADULT PER CHILD

2014 2015 2016

OR THE % OF FAMILY INCOME

$95 $47.50 $325

$162.50 $695

$347.50

PER ADULT PER CHILD

2014 2015 2016

1% OF FAMILY INCOME IN 2014 – 2% IN 2015 – 2.5% IN 2016

3.5 Million +

Is your current coverage ok?

Probably – but check with your employer or insurance agent

IF YOU’RE COVERED BY MEDICARE OR MEDICAID, YOU HAVE THE REQUIRED COVERAGE

Other approved coverage

Plans from your state insurance marketplace

Other approved coverage

Plans from your state insurance marketplace

Other government programs

CHECK HEALTHCARE.GOV

What if you lose your coverage?

You are allowed 3 months or less for lapsed coverage

You are allowed 3 months or less for lapsed coverage

AFTER THAT, YOU ARE SUBJECT TO THE TAX PENALTY

Do you have to cover dependents?

YES

YES

If they qualify as dependents under the IRS Code

YES

If they qualify as dependents under the IRS Code

IT GETS TRICKY WITH CUSTODIAL VERSUS NON-CUSTODIAL PARENTS SO CHECK WITH

YOUR TAX CONSULTANT IF THIS APPLIES

When does the mandate start?

Open enrollment

for state insurance marketplace starts October 1, 2013

CHECK HEALTHCARE.GOV FOR DETAILS IN YOUR STATE

What’s your next steps?

CHECK REQUIREMENT

• Are you required to have coverage?

• Are you excluded from the requirement?

CHECK OPTIONS

• Employer coverage?

• Government program?

• Buy your own?

CHECK FINANCIAL HELP

• Are you eligible for premium help?

• If employer coverage, any incentives to lower your cost?

Helpful Resources

HealthCare.Gov

Subsidy calculator at Kaiser Family Foundation KFF.org

Cathy Miller, Business Writer

Business site:

www.SimplyStatedBusiness.com

Want more health care information? Visit my health care blog at

www.SimplyStatedHealthCare.com