The Open Enrollment Period for Mandated Health Coverage Has Passed

The open enrollment period for mandated health care coverage in 2014 ended on March 31, 2014.  Hopefully, you either have insurance through your work or have already signed up for  coverage (known as minimum essential coverage) for yourself and everyone in your family.  If you don’t have health insurance, you may have to go without for the remainder of 2014, because the next Open Enrollment Period for 2015 coverage isn’t until  November 15, 2014 – February 15, 2015.

If you don’t maintain health insurance coverage, you will need to either seek an exemption or make an individual shared responsibility payment for the period that you are not covered with the 2014 income tax return you file in 2015.

If you purchased health insurance coverage through the Marketplace, you may be eligible for financial assistance including the Premium Tax Credit, which will help lower the out-of-pocket cost of your monthly insurance premiums.

Qualifying coverage does not include certain coverage that may provide limited benefits, such as coverage only for vision care or dental care, workers’ compensation, or coverage only for a specific disease or condition.

If you choose to go without coverage or experience a gap in coverage, you may qualify for an exemption if you do not have access to affordable coverage, you have a gap of less than three consecutive months without coverage, or you qualify for one of several other exemptions.  A special hardship exemption applies to individuals who purchase their insurance through the Marketplace during the initial enrollment period but due to the enrollment process have a coverage gap at the beginning of 2014.

If you (or any of your dependents) do not maintain coverage and do not qualify for an exemption, you will need to make an individual shared responsibility payment with your 2014 return. In general, the payment amount is either a percentage of your household income or a flat dollar amount, whichever is greater.  You will owe 1/12th of the annual payment for each month you (or your dependents) do not have coverage and are not exempt.

The annual payment amount for 2014 is the greater of:

•    1 percent of your household income that is above the tax return filing threshold for your filing status, such as Married Filing Jointly or single, or
•    Your family’s flat dollar amount, which is $95 per adult and $47.50 per child, limited to a maximum of $285.

The individual shared responsibility payment is capped at the cost of the national average premium for the bronze level health plan available through the Marketplace in 2014.  You will make the payment when you file your 2014 federal income tax return in 2015.

For more information about the individual shared responsibility provision and the premium tax credit, visit IRS.gov/aca. Visit the Department of Health and Human Services at HealthCare.gov for more information about health insurance coverage options and the Health Insurance Marketplace, financial assistance and exemptions.

The IRS launched a new website page called “The Individual Shared Responsibility” on March 25, 2014, which gives even more details about this element of the mandate.

If you believe you might qualify for an exemption, you should apply for an exemption before you file your taxes for 2015 or you might wind up paying a penalty you need not pay.  Check out this website:  How do I qualify for an exemption from the fee for not having health coverage?  It tells you what forms to fill out and where to send the information.