Your Source for Health Reform

Topic: Individual Mandate



The ACA requires that everyone have health coverage in some form. Those who not have insurance, and do not fall into one of the exemption categories, are subject to a penalty. The penalty fee is $95 or prorated 1% of income for 2014, and increases in later years. The constitutionality of this part of the law was challenged, and was upheld by the U.S. Supreme Court.


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Paying Taxes Without Insurance

A January 2015 issue brief from the Centers for Medicare and Medicaid Services outlines what uninsured tax payers should expect during the upcoming tax season. The brief identifies exempt populations and where to get tax help.

The ACA’s Changes to Tax Returns

This December 2014 question and answer from the IRS outlines changes to tax filing because of the healthcare reform law. The IRS details how individuals report minimum essential coverage on their tax forms and how to reconcile or claim premium tax credits.

When the Individual Mandate Doesn’t Apply

This September 2014 fact sheet from the IRS highlights cases that would exempt individuals from purchasing health insurance. The sheet identifies whether individuals should seek an exemption from the IRS or the marketplace.

Individual Mandate Relief for Employer Plan-Year Gaps

This brief from the ADP Research institutes explains that transitional relief is available to employees and their spouses and dependents, who are eligible to enroll in employer-sponsored group health plans with a plan year that runs on a non-calendar year basis that begins in 2013 and ends in 2014. (more…)

Types of Exemptions from the Requirement to Have Health Insurance

This 2013 chart from Families USA provides an overview of the different reasons you could get an exemption, where and when you need to apply, and how long each type of exemption lasts.

Understanding the Requirement to Have Health Insurance

This 2013 fact sheet from Families USA answers common questions about the ACA’s requirement that everyone must have health insurance that covers their basic health needs.

On the IRS Individual Mandate Rules

The IRS released the final rules on August 27, 2013, for the individual mandate and associated “shared responsibility payment.” These rules largely finalize the proposed version of the rules issued earlier in the year, with a few modifications. This preliminary analysis courtesy of Jackson Hewitt Tax Service Inc. summarizes the final rules.

The ACA Individual Mandate and Related Requirements

This August 2014 report from the Congressional Research Service describes the ACA requirement for individuals to maintain minimum essential insurance coverage, which could take the form of eligible employer-sponsored coverage, individual coverage, grandfathered health plans, and federal programs such as Medicare and Medicaid, among others. There are some exceptions to the requirement. (more…)

Federal Rules on Individual Shared Responsibility Exemptions

This June 2013 CMS fact sheet summarizes federal eligibility rules for receiving an exemption from the individual shared responsibility provision. The rules will ease implementation and help to ensure that the shared responsibility payment obligation applies only to the limited group of taxpayers who have ready access to affordable coverage but choose to spend a substantial period of time uninsured. (more…)

A Guide to the Supreme Court’s Affordable Care Act Decision

This policy brief from the Kaiser Family Foundation describes the Court’s decision and looks ahead to the implementation of health reform now that the constitutionality of the ACA has been resolved. The brief contains sections describing the background to the case, specifics pertaining to the individual mandate and Medicaid expansion, as well as how the overall decision will affect the future.

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