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The 4 W’s of the Obamacare Individual Mandate

Victor E. Battles, M.D.  - Dec. 8, 2013

In shedding light on the individual mandate of the Affordable Care Act, also known as Obamacare, what, who and when questions need to be answered. Answers to these all important questions explain not only what the mandate is, but to whom it applies, how it will be enforced, and when it will be enforced. Okay. Let’s cut to the chase. 

What is the Affordable Care Act individual mandate?  

It is the requirement for most residents of the United States to purchase health insurance which provides the essential benefits as stated in the Affordable Care Act or face a penalty.  

When will the mandate take effect? 

Nonexempt individuals must be enrolled in an Affordable Care Act insurance plan by January 1, 2014. 

Who must purchase ACC insurance so as to be in compliance with the mandate? 

This question is best answered by designating who is exempt from complying with the mandate. Every citizen and legal resident must purchase health insurance except for the following: 

·         Individuals insured for a whole year through one or a combination of the following insurance plans: Medicare, Medicaid, Children's Health Insurance Program, TRICARE, the Veteran’s Health Program, a plan offered by an employer, a previously purchased health plan of at least the bronze level, and a grandfathered health plan which was purchased on or before March 23, 2010. 

·         Undocumented immigrants 

·         Members of an Indian tribe 

·         Incarcerated individuals 

·         Individuals who belong to a religious group who are opposed to accepting benefits from a health insurance policy based on beliefs of that religion 

·         Individuals whose household income is less than the threshold for filing an income tax return ($10,000 for an individual and $20,000 for family and 2013) 

·         Individuals who would have to pay 8% or more of his or her income for health insurance, after taking into account contributions by an employer or tax credits 

What is the penalty and assessment timetable? 

In 2014 the penalty is a tax of $95 per adult and $47.50 per child up to a maximum of $285 for a family household or 1% of the family household income (whichever is greater). The penalty will go up to $325 per adult and $162.50 per child (up to a maximum of $975 per family household) or 2% of the family household income (whichever is greater) in 2015. In 2016 the penalty will increase to $695 per adult and $347 per child (up to $2085 for a family household) or 2.5% of the household income (whichever is greater). After 2016 the penalty will be increased annually based on increases in the cost of living.  

The penalty is assessed once a nonexempt person has been without qualifying insurance for three months out of the year. The penalty assessment is prorated based on the number of months that insurance has been lacking. If for example, one has been without insurance for six months out of the year, which is 50% of the year, the tax penalty as applicable and specified above would be half the amount.



Learn more about health insurance in this era of healthcare reform.


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