Beginning January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) requires individuals to carry comprehensive health insurance (referred to as minimum essential coverage or MEC). Individuals without coverage must make a shared responsibility payment to the IRS, unless they qualify for an exemption. This requirement is known as the individual mandate. The individual mandate also applies to children and other dependents.
Minimum essential coverage
The individual mandate applies on a monthly basis. The payment amount is based on the number of months in the calendar year that the individual lacks MEC and does not have an exemption. An individual who is covered by health insurance that provides MEC will not owe the payment. MEC includes certain government-sponsored coverage, such as Medicare, most employer group health plans, and coverage offered in the individual market.
Affordability and other exemptions
The payment does not apply if the coverage available to the employee is not “affordable.” MEC is not affordable if it costs more than eight percent of the taxpayer’s household income for the year. If an individual is not eligible for employer coverage, the individual’s minimum required contribution is the premium for the lowest cost bronze-level plan offered by an affordable insurance exchange.
There are nine categories of exemptions from the individual mandate. These include religious, Indians, individuals who do not have to file a return, hardship, and unaffordable coverage.
The payment owed by an individual without coverage or an exemption is the lesser of: the monthly payment amount for each individual (maximum three family members), or the monthly national average bronze plan premiums for the family. The monthly payment amount is the greater of: a flat dollar amount, or the excess income amount. The flat dollar amounts are $95 in 2014, $325 in 2015, $695 in 2016, and an indexed amount amount after 2016. The amount is cut in half for an individual under 18.
The excess income amount is the excess of the taxpayer’s household income over the taxpayer’s filing threshold, multiplied by a percentage. The percentage is 1.0 percent for 2014; 2.0 percent for 2015, and 2.5 percent after 2015.
A taxpayer must report liability for the payment on the taxpayer’s income tax return. The penalty is payable upon notice and demand by the IRS. Because the IRS cannot use liens or levies to collect the payment, it expects to collect the payment primarily through refund offsets.