Have Health Insurance or Potentially Pay a Penalty

You’ve heard a lot of buzz about healthcare reform and now you want to know how it will affect you and your family! We’ve got the answers on everything you need to know about what’s new in the health insurance market.

In 2014, the Affordable Care Act (ACA) implemented a mandate for most individuals to have health insurance or potentially pay a penalty for non-compliance. You will be required to maintain minimum essential coverage for you and your family to avoid this penalty. Some individuals will be exempt from the mandate or the penalty, while others may be given financial assistance to help them pay for the cost of health insurance.

Minimum essential coverage satisfies the individual mandate. What does minimum essential coverage mean?

Minimum essential coverage is any insurance plan that meets the Affordable Care Act (ACA) requirements for having health coverage (as defined by healthcare.gov)
Examples of plans that meet this requirement:

  • Coverage under certain government-sponsored plans (i.e. Medicare, Tricare)
  • Employer-sponsored plans, with respect to any employee
  • Plans in the individual market
  • Any other health benefits coverage that meets the Affordable Care Act mandates

Examples of plans that don’t meet this requirement:

  • Plans that cover only dental or vision care
  • Workers’ Compensation
  • Plans that cover only a specific disease or condition
  • Plans that only offer discounts on medical services, but do not provide overall healthcare coverage

For a full list and details on plans that may or may not meet coverage requirements, please visit healthcare.gov.

What is the penalty for noncompliance?

For 2017: $695 per uninsured Adult and $347.50 per uninsured child, or 2.5 percent of household adjusted gross income; whichever is greater.. There are caps on these penalties however. If you are paying per person, the maximum allowed penalty for 2017 is $2,085. If you are paying by adjusted gross income, the maximum allowed penalty for 2017 is, “the total yearly premium for the national average price of a Bronze plan sold through the Marketplace” (as defined by healthcare.gov).

Who will be exempt from the mandate?

Individuals can be exempt from some or all of these penalties under certain circumstances. Below are some common examples, but please visit healthcare.gov for a full list and details.

  • Not meeting minimum income standards
  • Certain Financial or other hardships
  • Individuals were insured for part of the year
  • Certain exempt religious organizations
  • Member of a federally recognized tribe

The information provided above is for educational purposes only and not a substitute for professional advice. While Sanford Health Plan tries to keep the information as accurate as possible, health care information changes rapidly and thus this information should not be relied upon as comprehensive or error free. In no event will Sanford Health Plan be liable to you or anyone else for any decision made or action taken by you or anyone else in reliance upon the information contained on this page.