The individual responsibility requirement, also known as the individual mandate, is a provision of the Affordable Care Act requiring that all citizens obtain a minimum standard of health insurance coverage starting in 2014, obtain an exemption, or pay an extra fee (a tax) when filing their federal income tax return. People can obtain the necessary coverage through their job, through a government program such as Medicaid or Medicare, or through the health insurance marketplace in their state. Exemptions from the individual mandate are also available to those that qualify. Most exemptions can be obtained through the tax filing process, but certain exemptions must be applied for and granted through the health insurance marketplace.
Individual Responsibility Requirement (Individual Mandate)
- I’m uninsured. Am I required to get coverage?
- How do I prove that I had coverage and satisfied the mandate?
- What’s the penalty if I don’t have coverage?
- If I owe a penalty, when and how do I have to pay it?
- I heard that the mandate to have health insurance no longer applies. Is that correct?
- Are there exemptions to the penalty? What are they?
- How do I apply for an exemption?
- On what grounds can I apply for a hardship exemption to the individual mandate?
- Do I have to buy a plan by the end of open enrollment (i.e., for 2018 coverage, by December 15, 2017) to avoid a tax penalty?
- If I change health coverage during the year and end up with a gap when I am not covered, will I owe a tax penalty?
- I lost coverage March 15 and didn’t get new coverage until April 1. Am I considered uninsured for the month of March because I lacked coverage for part of the month?
- I live overseas. Do I still have to comply with the individual mandate?
- My family isn’t eligible for subsidies in the marketplace because I am eligible for self-only coverage at work that is considered affordable. But we can’t afford to buy marketplace coverage on our own. Will my family and I have to pay a penalty?
- This summer I didn't sign up for my employer plan because premiums were too high. I just found out I won't qualify for premium tax credits with a marketplace plan because an employer plan is available to me. Will I have to pay a penalty?
- I can’t afford to continue my health insurance premiums because of hurricane/wildfire related expenses. Do I qualify for an exemption or will I have to pay a penalty for being uninsured?
- How do I know if my coverage counts so I can avoid paying the tax penalty?
- Do private insurance policies have to be labeled to show whether they are minimum essential coverage?
- I’m in a grandfathered plan that doesn’t cover prescription drugs. Does that count as minimum essential coverage?
- Does the individual mandate require me to purchase dental coverage for me or my child?
- Short-term policies are for sale outside of the marketplace and they are much cheaper than many other policies. What is a short-term policy? If I buy a short-term policy, does that satisfy the requirement to have minimum essential coverage?
- I have Medicaid coverage just for the care I need while I’m pregnant. Does that count for the individual responsibility requirement?
- What types of Medicaid coverage are not considered minimum essential coverage?
- I have a marketplace plan and am receiving premium tax credits. I am now pregnant. Since I’m eligible for pregnancy-related Medicaid coverage, am I required to drop my marketplace plan and lose my financial assistance?