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

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