Beginning January 1, 2014 most Americans will be required to carry health insurance for
themselves and their dependents or pay a penalty when they ﬁle their tax return. This is known as the Individual Mandate of the Patient Protection and Aﬀordable Care Act. If one of the following applies to you then you are not required to obtain health insurance:
1. Members of certain religious groups and Native American tribes
2. Undocumented immigrants
3. Incarcerated individuals
4. People whose incomes are so low they don't have to ﬁle taxes
5. People with household income below 100% of the federal poverty level in states that did not expand Medicaid
6. People who are uninsured for a period that is less than 3 months
7. People for whom health insurance is considered unaﬀordable (where insurance premiums after employer contributions and federal subsidies exceed 8% of family income)
If you already have qualiﬁed health insurance, you are covered and are not required to take any action. Examples of qualiﬁed health insurance include:
2. Medicaid or Children's Health Insurance Program (CHIP)
3. TRICARE for Life program
4. Veterans’ health care
5. Health coverage plan available to Peace Corps volunteers
6. Employer-sponsored plans, provided that:
a. The plan covers at least 60% of covered costs.
b. The employee’s cost for self-only coverage is not more than 9.5% of the employee’s household income. If the cost of the insurance is more than 9.5% of household income, the employee may be eligible for a subsidy if they purchase insurance through a Health Insurance Marketplace (or Exchange). They must opt out of the employer insurance: they cannot be enrolled in qualiﬁed insurance and be eligible for the premium assistance credit, even if that insurance is greater than 9.5% of household income.
If you are not exempt and are not covered by qualiﬁed health insurance, you may qualify for a premium assistance credit to help oﬀset the cost of the insurance if you buy insurance through a government-run Exchange. Household income must be between 100%–400% of the federal poverty level to be eligible for a credit. To determine if you qualify for the premium assistance credit, what the maximum cost of insurance would be, and what the penalty would be for going without insurance please use our free calculator.