The individual shared responsibility provision is part of the Affordable Care Act that includes the act itself, state governments, the federal government, employers, individuals and insurers. Each party has a shared responsibility to improve and reform the quality, affordability and availability of health coverage. In 2014, the shared responsibility provision requires every individual to carry minimum essential coverage, pay the tax penalty or qualify for an exemption.
Effective Date, Applicable Parties And Transition Relief
This provision takes effect on the first day of 2014 and is applicable for every calendar month. Both adults and children are applicable parties for this provision, and adults claiming dependent children are the responsible parties for providing coverage or paying the tax penalty if the children or individuals themselves do not have exemptions. Individuals who are eligible for employer-sponsored plans may qualify for transition relief from the shared responsibility payment. Employees or those who have relationships to employees who are eligible to enroll in employer-sponsored plans that are not based on calendar years may qualify for relief.
Minimum Essential Coverage
Minimum essential coverage does not include plans that cover only limited benefits such as dental, vision or disability. The following are considered minimum essential coverage:
– Coverage from the individual market such as qualified health plans.
– Employer-sponsored plans, retiree coverage and COBRA.
– The majority of Medicaid plans.
– Medicare Advantage plans and Medicare Part A coverage.
– Several types of VA coverage and Peace Corps insurance for volunteers.
– Children’s Health Insurance Program coverage and TRICARE.
– Refugee medical assistance from the ACF.
– State high-risk pools that fit outlined criteria.
– Self-funded coverage for university students that fit outlined criteria.
There are also several exemptions from obtaining minimum essential coverage. These include the following:
– People who are members of specific religious sects opposing insurance benefits.
– Members of recognized health care sharing ministries.
– Members of recognized Indian tribes.
– People whose income levels are below the income tax filing threshold.
– People who were without insurance for three consecutive months during one year.
– People who would have to pay more than eight percent of their income for premiums.
– People who meet the Affordable Insurance Exchange’s hardship criteria.
– Some U.S. citizens who are not physically living in the United States.
– People who are incarcerated.
Qualifying For Exemptions Or Obtaining Adequate Coverage
Most people who are currently insured will not need to do anything to be considered as adequately insured in 2014. People who are uninsured should discuss their options with an agent. For those who want an exemption, an agent will be able to provide information from the Health Insurance Marketplace for several exemption categories. However, those who are already exempt due to income will not need to take any further action. It is important to remember that both children and senior citizens must also be adequately insured or qualify for an exemption. A person who has coverage through a spouse’s employer-sponsored plan is also considered to be adequately insured. However, spouses and children can be covered under a different approved plan to qualify as well.
What To Expect Without Coverage In 2014
If a person without coverage needs care, everyone else will have to pick up the bill. This is why the health care law makes it mandatory for all people who can afford coverage to obtain it or pay a fine. Those who do not have coverage will have to pay the entirety of their individual bills, which may be high enough that they lead to bankruptcy in some cases. The fee in 2014 is one percent of a person’s income or $95 for each person. However, the fee amount will increase every year. By 2016, it will be $695 per person or 2.5 percent of annual income. The fee for uninsured children starts at $47.50 with a maximum of $285 regardless of the number of children a family has. Consumers must keep in mind that these are just fees and not coverage, so they are still responsible for all medical bills. For answers to further questions, call ACBI at 203-259-7580 or visit our website by clicking here.