Do I have to get insurance? What is the "individual mandate"?

Do I have to get insurance?  What is the "individual mandate"?

  • Individuals who are eligible for health insurance must get it (with some exceptions).  If eligible individuals don't get insurance, they will have to pay a fee to the federal government.
  • The fee in 2014 will be 1% of yearly income OR $95 per person, whichever is higher.  The fee is scheduled to increase every year.

Individuals have until March 31, 2014 to enroll in a Qualified Health Plan through the Marketplace for 2014. To have Marketplace insurance coverage that begins in January 2014, individuals must enroll by December 23, 2013.

Who is exempted from the individual mandate?

  • People who already have insurance that qualifies as "minimum essential coverage" (such as Medicare, Medicaid/TennCare, TRICARE)
  • People who are uninsured for less than 3 months of the year
  • People who are determined to have very low income, and coverage is considered unaffordable
  • People who are not required to file a tax return because their income is so low
  • People who would qualify for Medicaid, but their state is not accepting nwe Medicaid applicants
  • People who are members of federally-recognized Indian tribes
  • People who participate in a health-sharing ministry
  • People who are members of recognized religious sects with religious objections to health insurance
  • People who are incarcerated
  • People who are undocumented immigrants
  • People who already have "affordable health insurance" through their employer do not have to change.  "Affordable health insurance" is defined as having monthly premiums not more than 9.5% of monthly net income.
  • People who have affordable health insurance through their employer can still enroll in a different plan through the Marketplace, but would not be eligible for premium tax assistance.
  • People who do not qualify under these rules may also apply for an exemption.