Penalties

Household/Individuals

  • The penalty in 2014 is calculated one of 2 ways. You’ll pay whichever of these amounts is higher:
  • $95 per person for the year ($47.50 per child under 18) $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.
  • 1% of your yearly household income. The maximum penalty is the national average yearly premium for a bronze plan.

Household/Individuals

  • In 2015 it’s 2% of income or $325 per person.

Big Businesses (50 or more full-time equivalent employees) will face penalties if:)

  • If a business does not offer insurance, the annual payment is $2000 per full-time employee (excluding the first 30 employees)
  • If a business does offer insurance, but the insurance plan does not meet the minimum standards, the annual payment is $3000 per full-time employee who qualifies for savings in the Marketplace These payments are not tax deductible.

Household/Individuals

  • In 2016 and later years it’s 2.5% of income or $695 per person.
  • After 2016, it is adjusted for inflation.

Big Businesses (50 or more full-time equivalent employees) will face penalties if:)

  • If a business does not offer insurance, the annual payment is $2000 per full-time employee (excluding the first 30 employees)
  • If a business does offer insurance, but the insurance plan does not meet the minimum standards, the annual payment is $3000 per full-time employee who qualifies for savings in the Marketplace These payments are not tax deductible.

Exemptions

You may qualify for an exemption if:
  • You’re uninsured for less than 3 months of the year
  • The lowest-priced coverage available to you would cost more than 8% of your household income
  • You don’t have to file a tax return because your income is too low
  • You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
  • You’re a member of a recognized health care sharing ministry
  • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
  • You’re incarcerated, and not awaiting the disposition of charges against you
  • You’re not lawfully present in the U.S.
  • Hardship exemptions:
  • If you have any of the circumstances below that affect your ability to purchase health insurance coverage, you may qualify for a “hardship” exemption
    • You were homeless.
    • You were evicted in the past 6 months or were facing eviction or foreclosure.
    • You received a shut-off notice from a utility company.
    • You recently experienced domestic violence.
    • You recently experienced the death of a close family member.
    • You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
    • You filed for bankruptcy in the last 6 months.
    • You had medical expenses you couldn’t pay in the last 24 months.
    • You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
    • You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
    • As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.
    • You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.

Other Key Facts

  • If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you’re uninsured for less than 3 months, you don’t have a make a payment.
References