QUESTION

How do I know if my coverage counts so I can avoid paying the tax penalty?

Individuals with no coverage | Individual Responsibility Requirement (Individual Mandate)
ANSWER

To meet the coverage requirement, individuals must have “minimum essential coverage.” Most people that have health coverage today have a plan that will count as minimum essential coverage, and will not need to do anything more than continue the coverage that they have. If you have any of the following types of coverage, you likely have minimum essential coverage:

  • Employer-sponsored coverage, including COBRA continuation coverage and retiree coverage
  • Coverage purchased in the individual market, including a plan purchased in a health insurance marketplace
  • Medicare Part A coverage and Medicare Advantage plans
  • Most Medicaid coverage
  • Most Children’s Health Insurance Program coverage
  • Veterans health coverage administered by the Veterans Administration that are comprehensive
  • Most types of TRICARE (coverage for members of the military)
  • Self-funded student health coverage that began on or before Dec. 31, 2014 (for later plan or policy years, programs can apply to be recognized as minimum essential coverage, the list of approved plans is available here 
  • Coverage for Peace Corps volunteers
  • Refugee Medical Assistance from the federal Administration for Children and Families
  • Department of Defense health benefit program for civilian employees known as “Non Appropriated Fund” personnel

All health insurers must provide individuals with a Summary of Benefits and Coverage, which uses a standard format to outline the benefits, cost-sharing and coverage limits of plans. The Summary of Benefits and Coverage must also state whether the plan meets minimum value and counts as minimum essential coverage.

If you don’t currently have coverage, will soon lose coverage, or are thinking of changing coverage, you can obtain minimum essential coverage by purchasing a plan on your state’s health insurance marketplace.

Some types of coverage sold outside a health insurance marketplace do not qualify as minimum essential coverage, such as discount plans, short-term policies, or policies that cover only cancer. These kinds of products are sometimes referred to as “excepted benefits.” They do not count as minimum essential coverage.

If you are uncertain whether your plan qualifies as minimum essential coverage, contact your employer’s human resources department or your health insurer. (26 U.S.C. § 5000A (f); 45 C.F.R. § 156.602). 

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues