Individual Mandate: What if you don't have health coverage in 2014?
If you can afford health insurance doesn’t have coverage in 2014, you may have to pay a fee in addition to all of your health care costs.
The fee in 2014 and beyond
The fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher. In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.
Just because you pay the fee doesn’t mean you have health insurance coverage. You still will be responsible for 100% of the cost of your medical care.
After open enrollment ends on March 31, 2014, you won't be able to get health coverage through the Marketplace until the next annual enrollment period, unless you have a qualifying life event.
Minimum essential coverage
To avoid the fee in 2014 you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following in 2014, you're considered covered and don't have to pay a penalty:
- Any Marketplace plan, or any individual insurance plan you already have
- Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
- The Children's Health Insurance Program (CHIP)
- TRICARE (for veterans and veteran families)
- Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
- Peace Corps Volunteer plans
Other plans may also qualify. Ask your insurance agent for help to determine if you have the right coverage.
Who doesn't have to pay the fee?
Uninsured people won't have to pay a fee if they:
- are uninsured for less than 3 months of the year
- are determined to have a very low income and coverage is considered unaffordable
- are not required to file a tax return because their income is too low
- would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility
- are a member of a federally recognized Indian tribe
- participate in a health care sharing ministry
- are a member of a recognized religious sect with religious objections to health insurance
If you don't qualify for these situations, you can apply for an exemption asking not to pay a fee. You do this in the Marketplace.
What health insurance doesn’t qualify as coverage?
Health plans that don't meet minimum essential coverage don't qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include:
- coverage only for vision care or dental care
- workers' compensation
- coverage only for a specific disease or condition
- policies that offer only discounts on medical services
This is a summary of certain aspects of the Affordable Care Act, current as of November 11, 2013. You can view the original source for this summary at https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/ or contact us for a printed copy.