July 10, 2013

Legislative Update
Affordable Care Act Question of the Week: Minimum Essential Coverage [All Markets]

The “Question of the Week” answers frequently asked questions regarding the Affordable Care Act (ACA). This week, we feature a question about Minimum Essential Coverage.

Q. What happens to individuals who fail to meet the requirement to have health insurance in 2014?

A. Beginning Jan. 1, 2014, most U.S. citizens and legal residents will be required to have health insurance that meets minimum essential coverage or pay a tax penalty. In 2014, the penalty is $95 per adult and $47.50 per child (up to $285 for a family) or 1 percent of income, whichever is greater. However, there are some exemptions to the "minimum essential coverage" requirement.
 
Exemptions to the "minimum coverage requirement" include those who:

1. Cannot afford coverage
2. Meet religious objection requirements
3. Have income below the minimum threshold for filing a tax return. (For example, in 2012, the threshold to file a tax return was $9,750 for an individual; $12,500 for a head of household; or $19,500 for married filing jointly.)
4. Are members of a health care sharing ministry
5. Are members of an Indian tribe
6. Have suffered a hardship. This includes:
   1. Individuals who are projected to have no offer of affordable coverage;
   2. Individuals who are not required to file an income tax return, but who technically fall outside the filing threshold statutory exemption; and
   3. Individuals who would be eligible for Medicaid, but for a state’s choice not to expand Medicaid eligibility. The hardship exemption will be available on a case-by-case basis for individuals who face other unexpected personal or financial circumstances that prevent them from obtaining coverage.
7. Are in prison or jail
8. Have coverage gaps of less than three months in a year
9. Are undocumented immigrants