In 2014 it’s the law that with few exceptions everyone must maintain insurance that meets minimum essential coverage. While for the most part insurance rates have not come down the good news is there are significant subsidies available that both help with paying for coverage and for helping to meet up front and out of pocket expenses.
Who is eligible for the premium tax credit?
An individual is eligible for the premium tax credit if he or she meets all of the following requirements:
- Purchases coverage through the Marketplace.
- Has household income that falls within a certain range.
- Is not able to get affordable coverage through an eligible employer plan that provides minimum value.
- Is not eligible for coverage through a government program, like Medicaid, Medicare, CHIP or TRICARE.
- Files a joint return, if married.
- Cannot be claimed as a dependent by another person.
Glandon Insurance has their FFM Certification and can help you purchase coverage through the exchange.
To find out if you may be eligible to receive either premium or cost sharing subsidies: Subsidy Calculator
Who is subject to the individual shared responsibility provision?
The provision applies to individuals of all ages, including children. The adult or married couple who can claim a child or another individual as a dependent for federal income tax purposes is responsible for making the payment if the dependent does not have coverage or an exemption.
When does the individual shared responsibility provision go into effect?
The provision is effective as of January 1, 2014 and applies to each month in the calendar year.
In order to provide transition relief during the first year the penalty tax applies to individuals, an employee (or an individual having a relationship to the employee) who is eligible to enroll in a non-calendar year eligible employer-sponsored plan with a plan year beginning in 2013 and ending in 2014 will not be liable for the penalty tax for certain months in 2014. The transition relief begins in January 2014 and continues through the month in which the 2013–2014 plan year ends.
What counts as minimum essential coverage?
Minimum essential coverage includes employer-sponsored coverage (including self-insured plans, COBRA coverage and retiree coverage), coverage purchased in the individual market, Medicare Part A coverage and Medicare Advantage, Children’s Health Insurance Program (CHIP) coverage, and certain other types of coverage.
Calculating the Payment
The penalty in 2014 is calculated one of 2 ways. In general, individuals will pay whichever of the following amounts is higher:
- 1% of the individual’s yearly household income above his or her applicable filing threshold (the amount of gross income that triggers the requirement to file a federal income tax return). The maximum penalty is the national average yearly premium for a bronze plan.
- $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.
The fee increases every year. In 2015, it increases to 2% of income or $325 per person. In 2016 and later years, the fee is 2.5% of income or $695 per person. After that it is adjusted for inflation.
If an individual is uninsured for just part of the year, 1/12 of the yearly penalty applies to each month the individual is uninsured. (If an individual is uninsured for less than 3 months, the individual does not have to make a payment.)