Individual Mandate: What If You Don’t Have Health Coverage in 2015

If you can afford health insurance but don’t have coverage in 2015, you may have to pay a fee in addition to all of your health care costs.

The fee in 2015

The fee for not having health coverage is calculated one of 2 ways. If you or your dependents don’t have insurance that qualifies as minimum essential coverage you'll pay either a percentage of your household income or a flat fee -- whichever is higher.

  • 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
  • $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.

Minimum essential coverage

To avoid the fee in 2015 you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following, you're considered covered and don't have to pay a penalty:

  • Any Marketplace plan, or any individual insurance plan you already have
  • Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
  • Medicare
  • Medicaid
  • The Children's Health Insurance Program (CHIP)
  • TRICARE (for veterans and veteran families)
  • Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
  • Peace Corps Volunteer plans

Other plans may also qualify. Ask your insurance agent for help to determine if you have the right coverage.

Who doesn't have to pay the fee?

Uninsured people won't have to pay a fee if they:

  • are uninsured for less than 3 months of the year
  • are determined to have a very low income and coverage is considered unaffordable
  • are not required to file a tax return because their income is too low
  • would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility
  • are a member of a federally recognized Indian tribe
  • participate in a health care sharing ministry
  • are a member of a recognized religious sect with religious objections to health insurance

If you don't qualify for these situations, you can apply for an exemption asking not to pay a fee. You do this in the Marketplace.

What health insurance doesn’t qualify as coverage?

Health plans that don't meet minimum essential coverage don't qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include:

  • coverage only for vision care or dental care
  • workers' compensation
  • coverage only for a specific disease or condition
  • policies that offer only discounts on medical services

 

This is a summary of certain aspects of the Affordable Care Act, current as of December 15, 2014. You can view the original source for this summary at https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/ or contact us for a printed copy.