The 4 W’s of the Obamacare Individual
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.
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.
will the mandate take effect?
Nonexempt individuals must be enrolled in an
Affordable Care Act insurance plan by January 1, 2014.
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:
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.
Members of an Indian tribe
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
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
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.