Individuals won’t pay a penalty if:

 

  • you are covered by your employer

  • you are covered by the government 
    (Medicare, Medicaid, CHIP, TRICARE or the VA)

  • you already have purchased coverage that meets the requirements for a Bronze Plan under the ACA

  • your income is low enough that your share of premiums (after federal subsidies and employer contributions) would total more than 8 percent of your income

  • your income is below the income tax filing threshold

  • you were uninsured for less than three months of the year (If over three, penalty is pro-rated)

  • you qualify for a religious exclusion

  • you are a member of a Native American tribe

  • you are an undocumented immigrant

  • you are in prison

The individual mandate, which requires most Americans (other than those who qualify for a hardship exemption) to carry a minimum level of health coverage, is still in effect for 2018

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Mandate

 

As part of the health care reform law, beginning in 2015, certain employers with 50 or more “full-time equivalent” employees (FTEs) who do not provide affordable health care coverage may be assessed a penalty if at least one full-time employee qualifies for a premium tax credit and uses it to purchase coverage in the health insurance exchange. Additionally, the law requires employers to provide prescribed health coverage while, at the same time, penalizing some employers who may fail to offer what is defined by the law as “affordable” coverage. 

 

The employer mandate provides two deterrents for business growth. First, the employer mandate discourages small businesses from hiring additional employees because only businesses with 50 or more FTEs may be penalized for not offering the prescribed coverage. Second, the employer mandate penalty, once triggered, is calculated based on the number of full-time employees.

 

Further, for the first time, this new law defines a full-time employee as someone who works 30 hours per week, averaged over the course of a month, rather than the traditional definition of 40 hours per week.

 

Employers want to offer health insurance to their employees and want to continue to grow and create jobs. However, the employer mandate threatens to penalize businesses for failing to offer affordable coverage, when—more than ever—people need jobs and employers need help growing and should be encouraged to hire more employees. This law does the opposite at a dangerous time.

If you think you are overpaying in healthcare check out the Healthcare Bluebook!

The materials on this page have been developed for educational purposes only.  We urge you to consult with an attorney or benefit consultant to understand your legal obligations under the law. In many instances, the rules have yet to be written. Experts are continuing to debate how various provisions of the law will be implemented and enforced.  Many basic elements may change and there are numerous exceptions. Please contact an attorney or benefit consultant to verify how the law will affect your specific company, benefit offering, and scenario.

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