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Individual Mandate

Is it true that the IRS will accept a tax return even if it does not state the filer’s health coverage status?

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Yes, the IRS was set, for the first time this tax season to reject tax returns that did not include the filer’s health coverage status, but consistent with President Trump’s executive order seeking to minimize the burden of complying with ACA provisions, the IRS has decided to accept “silent” returns, those that do not state the filer’s health coverage status.

However, the individual mandate is still the law and individuals are expected to pay the penalty if they did not have required healthcare coverage during 2016. Additionally, this decision does not prevent the IRS from asking for proof of coverage at a later date and from assessing penalties if the filer did not maintain the required coverage.

This San Francisco Chronicle article provides helpful background information.

Where do individuals get the IRS forms to show that they had qualifying health care coverage and thus have complied with the Individual Mandate?

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If an individual had qualifying health care coverage, also known as minimum essential coverage, the provider of that coverage is required to send the individual a Form 1095‐A, 1095‐B, or 1095‐C (with Part III completed) that includes individuals in the family who were enrolled in the coverage and their months of coverage.

 

 

These forms must be sent on or before January 31 of the year following the calendar year in which minimum essential coverage is provided.  Even if individuals have not received one of these forms, but had health care coverage, according to the IRS, they can rely on other information they have about their coverage to complete their tax forms.  Consult with a tax advisor to determine what documents are acceptable.

How will the IRS know if an individual has maintained minimum essential coverage?

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Individuals and their dependents that had coverage for each month of the tax year, will indicate this on their tax return simply by checking a box on their Form 1040, 1040A or 1040EZ.

Is there an exemption for individuals who cannot afford health insurance?

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Individuals who cannot afford coverage, meaning the individual’s required contribution for coverage for the month exceeds 8% (indexed annually) of the individual’s household income; as well as taxpayers with income below the filing threshold are exempt from the individual mandate and thus will not be subject to the penalty.

 

If the individual is eligible for an employer-sponsored plan, the individual’s required contribution is the portion of the annual premium paid by the individual for the lowest cost self-only coverage or lowest cost family coverage that would cover the employee and all related individuals in the employee’s family. If the individual is not eligible for an employer-sponsored plan, the required contribution is the annual premium for the lowest cost bronze plan available in the Individual Marketplace in the rating area in which the individual resides, reduced by the amount of any premium credit received for the taxable year

 

There are also options that make coverage more affordable.  Individuals with household incomes for the taxable year below 138% of the federal poverty level (FPL) may be eligible for Medi-Cal if they also meet the other eligibility requirements.  Individuals with household incomes for the taxable year between 138% and 400% of the FPL may be eligible for premium assistance through Covered California if they also meet the other eligibility requirements. Individuals with household incomes for the taxable year within 138% and 250% of the FPL may also be eligible for a cost-sharing reduction through Covered California if they meet the other eligibility requirements.

What happens if someone does not use the Exchange for coverage? Are they charged a penalty? If so, how much?

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Non-exempt individuals and their dependents are required to maintain minimum essential coverage or pay a penalty. Minimum essential coverage includes government sponsored programs, eligible employer sponsored plans, plans in the individual market, grandfathered health plans, or other coverage (ex. state health benefit risk pool). There is no requirement to purchase coverage through the Exchange.

Are plans with limited benefits considered minimum essential coverage that will satisfy the individual mandate?

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Excepted Benefits are not minimum essential coverage.  Excepted Benefits means benefits under one or more (or any combination thereof) of the following:
(1) Benefits not subject to requirements
(A) Coverage only for accident, or disability income insurance, or any combination thereof.
(B) Coverage issued as a supplement to liability insurance.
(C) Liability insurance, including general liability insurance and automobile liability insurance.
(D) Workers’ compensation or similar insurance.
(E) Automobile medical payment insurance.
(F) Credit-only insurance.
(G) Coverage for on-site medical clinics.
(H) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

(2) Benefits not subject to requirements if offered separately
(A) Limited scope dental or vision benefits.
(B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
(C) Such other similar, limited benefits as are specified in regulations.

(3) Benefits not subject to requirements if offered as independent, noncoordinated benefits
(A) Coverage only for a specified disease or illness.
(B) Hospital indemnity or other fixed indemnity insurance.

(4) Benefits not subject to requirements if offered as separate insurance policy
Medicare supplemental health insurance (as defined under section 1395ss(g)(1) of this title), coverage supplemental to the coverage provided under chapter 55 of title 10, and similar supplemental coverage provided to coverage under a group health plan.

Is retiree coverage considered minimum essential coverage that will satisfy the individual mandate?

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Retiree coverage under an eligible employer-sponsored plan generally is minimum essential coverage.

What is an individual’s tax filing threshold?

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An individual’s tax filing threshold depends on their tax filing status, age, and income. More details can be found here:
http://www.irs.gov/publications/p501/ar02.html#en_US_2012_publink1000270109

Are undocumented immigrants subject to the individual mandate?

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Individuals not lawfully present are exempt from the individual mandate.

Are members of a health care sharing ministry subject to the individual mandate?

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Individuals who are members of a recognized health care sharing ministry are exempt from the individual mandate.

To qualify, a health care sharing ministry:

  1. must be a 501(c)(3) organization and be exempt from taxation under section 501(a)
  2. members of which must share a common set of ethical or religious beliefs and share medical expenses among members without regard to the state in which a member resides or is employed
  3. members of which must retain membership even after they develop a medical condition
  4. must have been in existence at all times since Dec. 31, 1999, and medical expenses of its members must have been shared continuously and without interruption since at least Dec. 31, 1999
  5. must conduct an annual audit performed by an independent CPA in accordance with generally accepted accounting principles and which is made available to the public upon request.

http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm