How does the Affordable Care Act (ACA) affect me as an individual?

Beginning in 2014, ACA requires individuals to maintain minimum essential health insurance coverage with some exceptions.

What is Minimum Essential Health Insurance Coverage?

  • Eligible employer-sponsored coverage;
  • Individual coverage;
  • Medicare and Medicaid;
  • State Children’s Health Insurance Program (CHIP);
  • TRICARE;
  • Department of Veterans Affairs health care program;
  • Peace Corps program.

 

How do I know if my employer’s plan meets Minimum Essential Coverage?

Every employer that provides minimum essential coverage must provide this information to each primary insured person.

What individuals are exempt from the individual mandate?

  • Individuals with qualifying religious exemptions;
  • Individuals whose household income is less than the filing threshold for federal income tax purposes ($10,000 single taxpayer; $16,100 married-filing-joint taxpayer);
  • Individuals whose required contribution for self-only coverage exceeds 8% of household income.

 

What is the penalty?

2014:

The greater of:

  • $95 for each taxpayer and any dependents, or
  • 1% of applicable income (amount household income exceeds the filing threshold).

2015:

The greater of:

  • $325 for each taxpayer and any dependents, or
  • 2% of applicable income (amount household income exceeds the filing threshold).

2016:

The greater of:

  • $695 for each taxpayer and any dependents, or
  • 2.5% of applicable income (amount household income exceeds the filing threshold).

 

When is the penalty assessed?

The individual mandate penalty will be assessed on the individual’s 2014 Form 1040.

Does the government help me pay the insurance premiums in the Health Insurance Marketplace?

There is a Premium Tax Credit available to people who:

  • Buy health insurance through the Marketplace;
  • Ineligible for coverage through an employer or government plan;
  • File a joint return, if married;
  • Cannot be claimed as a dependent by another person; and
  • Are within certain income limits:
    • Individuals up to $45,960;
    • Family of two up to $62,040;
    • Family of four up to $94,200.

 

How do I get the Premium Tax Credit?

  • Get it Now: Have some or all of the estimated credit paid in advance directly to your insurance company;
  • Get it Later: Wait to get all of the credit when you file your 2014 tax return in 2015.