Individual shared responsibility provision
The individual shared responsibility provision, less formally known as the individual mandate, is the health insurance mandate imposed on individuals by the Affordable Care Act in the United States. This individual mandate requires most individuals and their families to have a certain minimal amount of health insurance, with certain exemptions. Otherwise, they are required to pay the individual shared responsibility payment as a fine. The corresponding payment is the individual shared responsibility payment. It is one of the many Affordable Care Act tax provisions, and was repealed in December 2017 by the Tax Cuts and Jobs Act of 2017, but the repeal is not scheduled to take effect until 2019.
- The minimum amount that they must pay for annual premiums is more than eight percent of their household income.
- They have a gap in coverage for less than three consecutive months.
- They belong to a group explicitly exempted from participating.
- They qualify for an exemption for one of several other reasons, such as a hardship that prevents them from obtaining coverage.
Individuals and their families who have no health insurance, are required to make the shared responsibility payment.
The Patient Protection and Affordable Care Act signed in 2010 imposed a health insurance mandate to take effect in 2014. On June 28, 2012, the Supreme Court of the United States upheld the health insurance mandate as a valid tax, in the case of National Federation of Independent Business v. Sebelius and thus within Congress' taxing power.
Minimum essential coverage
Whether health care coverage qualifies as minimum essential coverage depends largely on the type of coverage it is. Most coverage that people have is considered to be minimum essential coverage. However, coverage providing only limited benefits does not qualify as minimum essential coverage.
|Coverage type||Examples||Qualifies as minimum
|Individual health coverage||
|Coverage under government-sponsored programs||
|Coverage that provides limited benefits||
If individuals or anyone in their families claim an exemption from minimum essential coverage, individuals are not required to make a shared responsibility payment. If individuals have a gross income below the tax return filing threshold for a certain year, they are automatically exempt from the shared responsibility provision for that year.
Most exemptions are claimed using Form 8965, Health Coverage Exemptions, when a tax return is filed. However, certain exemptions must be granted by the health insurance marketplace in advance, like coverage exemptions for certain hardship situations and for members of certain religious sects.
|Exemptions||Granted by marketplace,
claimed on tax return, or either
|Coverage is considered unaffordable||Tax return|
|Income below the return filing threshold||Tax return|
|Citizens living abroad||Tax return|
|Member of Indian tribe||Either|
|Member of certain religious sects||Marketplace|
|Resident of a state that did not expand Medicaid[which?]||Either|
Individuals without minimum essential coverage are required to make the shared responsibility payment, unless they qualify for exemptions. The worksheets located in the instructions to Form 8965, Health Coverage Exemptions, can be used to figure the shared responsibility payment amount that is due. The annual payment amount is a percentage of the household income in excess of the return filing threshold or a flat dollar amount, whichever is greater.
- Affordable Care Act tax provisions
- Form 1095
- Health insurance mandate
- Individual mandate
- Patient Protection and Affordable Care Act
- "Individual Shared Responsibility Provision". www.irs.gov. Retrieved 2016-02-14.
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- "The Individual Shared Responsibility Payment - An Overview". www.irs.gov. Retrieved 2016-02-14.
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- Pear, Robert. “Without the Insurance Mandate, Health Care’s Future May Be in Doubt”, The New York Times (December 18, 2017).
- Sullivan, Peter. “Senate GOP repeals ObamaCare mandate”, The Hill (December 2, 2017).
- Jost, Timothy. "The Tax Bill And The Individual Mandate: What Happened, And What Does It Mean?", Health Affairs (December 20, 2017).
- "The Individual Shared Responsibility Provision – The Basics – Veterans Reporter News". www.veteransreporternews.com. Retrieved 2016-08-23.
- "Individual Shared Responsibility Provision - Minimum Essential Coverage". www.irs.gov. Retrieved 2016-02-14.
- "Individual Shared Responsibility Provision – Exemptions: Claiming or Reporting". www.irs.gov. Retrieved 2016-02-14.
- "Form 8965 Health Coverage Exemptions" (PDF). Internal Revenue Service. Retrieved 2016-02-15.
- "Instructions for Form 8965" (PDF). Internal Revenue Service. Retrieved 2016-02-15.
- "Individual Shared Responsibility Provision – Reporting and Calculating the Payment". www.irs.gov. Retrieved 2016-02-14.
- Ebeling, Ashlea. "New Obamacare Tax This Filing Season: Your Shared Responsibility". Retrieved 2016-08-23.