The big Obamacare deadline looming on March 31 isn't just the last chance for most Americans to buy health insurance this year. It's also the last chance to avoid paying penalties under the Affordable Care Act's dreaded "individual mandate."
The individual mandate is one of the best-known but least-understood parts of President Barack Obama's signature health-care reform law. Here's how the mandate works, how much it costs to ignore the rule, and how you may be able to get out of it.
Who must have health insurance under Obamacare?
Practically everybody. But most Americans won't have to do anything on March 31. That's because about 80 percent of Americans already have health coverage -- through their jobs, a government program like Medicare or Medicaid, or directly from an insurance company. The small percentage of Americans who aren't insured risk having to pay a penalty under Obamacare. The complicated official name for this is the "individual shared responsibility payment." The IRS has more information, in case you thirst for still more complicated official language.
Who is exempt?
Many people are exempt from the mandate. Undocumented immigrants don't have to comply because they're not even allowed to use Obamacare's new insurance exchanges to buy coverage. Many Native Americans also don't have to comply, nor do those whose religious beliefs reject health insurance, people who don't make enough money to file federal income taxes, and people who can't find a health plan that costs less than 8 percent of their incomes. There's a full list here.
Then there's the "hardship exemption." The Obama administration is interpreting this part of the ACA very broadly, opening the door for lots and lots of people to potentially qualify.
There are 14 different categories of hardship exemption, including things like being homeless, experiencing a death in the family, and filing for bankruptcy. And the administration is letting anyone whose old insurance policy was canceled because it didn't meet Obamacare standards apply for an exemption. The vaguest exemption, and therefore potentially the most useful to people who don't want to get health coverage, is described as: "You experienced another hardship in obtaining health insurance." And for some of these 14 reasons, you're not even required to show documentation of your hardship.
What's the penalty for not having health insurance?
People who go without coverage for more than three months this year will owe the IRS money for each additional month they are uninsured when they file their federal income taxes next year. The minimum penalty is $95 for each adult in a household and $47.50 for each child younger than 18 years old, capped at $285 no matter how large a family is. There's also some wiggle room regarding the three-month grace period: Anyone who enrolls by the end of this month won't owe a penalty even though their benefits may not kick until May 1.
Most taxpayers subject to the penalty will owe more than that, though. Under the law, the amount is the higher of $95 or 1 percent of household income minus the first $10,150 for a single person or $20,300 for a married couple filing jointly. So a married couple with two minor children and $50,000 in taxable income would owe $297, according to a calculator created by the Tax Policy Center at the Brookings Institution.
But there's a limit to how much anyone would ever pay. The penalty is capped at the national average annual price for a "bronze" health insurance plan on the Obamacare exchanges, the lowest-level plan available to everyone. The IRS hasn't calculated what that amount is yet, but the Tax Policy Center estimates that it's $3,600 for a single person and $11,000 for a family of four.
The penalties start getting bigger next year and will be $695 or 2.5 percent of income by 2016. So being uninsured when you can afford coverage -- according to Obamacare, anyway -- will get expensive. While it's cheaper than health insurance, you don't get anything in return and are still responsible for paying your own medical bills.
How is the individual mandate enforced?
In a word? Lightly. The ACA doesn't let the IRS come after you if you don't pay the penalty. Failing to pay isn't a crime. The government can't garnish your wages or put liens on your property to collect the money. Basically, the only way the IRS can get the dough against your will is to deduct it from your tax refund.
What's more, the IRS really doesn't have any way of checking whether you're really insured if you say so when you file taxes.
Why are we doing all of this anyway again?
The theory behind the individual mandate is that the way to create an insurance market that lets people with pre-existing conditions get covered at reasonable prices is to make everyone participate.
Without some way to push healthy people into the insurance market, the fear is that it'll fall apart. Mostly sick people would get insurance, which would drive up prices, which would lead to healthier people deciding not to buy any, which would force insurers to raise rates to cover their expenses, which would lead to even more healthy people opting out. That cycle is called a "death spiral" in insurancespeak.
The individual mandate is not a popular policy at all for obvious reasons (Obama himself even used to oppose it). But the Supreme Court ruled two years ago that it's Constitutional, so we have to deal with it. Massachusetts has had an individual mandate since 2007, and it's worked out pretty well there.
Related
Before You Go
