HHS Provides Final Guidance on Who Must Buy Individual Health Insurance Coverage
Posted on Sep. 5, 2013

As you may recall, starting January 1 individuals must have health insurance coverage, qualify for an exemption or make a “shared responsibility payment” when filing a federal income tax return. This obligation still remains on the individual despite the employer mandate portion of healthcare reform being delayed.

Who exactly must buy insurance or pay a “fine” still remains a mystery to the people this law generally impacts. The Administration is trying to clarify that and recently issued the Final Rule on the who is in and who is exempt.

Perhaps most notable, if your state refuses to expand Medicaid eligibility, but had it done so you would have been eligible for Medicaid, you are exempt.

In general, individuals who are exempt fall into nine categories:

• Individuals who cannot afford coverage;

• Taxpayers with income below the filing threshold;

• Members of Indian tribes;

• Hardship;

• Individuals who experience short coverage gaps.

• Religious conscience;

• Members of a health care sharing ministry;

• Incarcerated individuals; and

• Individuals who are not lawfully present.

The full details of the Final Rule are located here: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-06-26.html.

If you have trouble sleeping, the IRS regs on shared responsibility payments are here: http://www.ofr.gov/(X(1)S(ba1p3y0dsh3rossow0xvp5mm))/OFRUpload/OFRData/2013-21157_PI.pdf.

The Treasury department press release announcing it all is here: http://www.treasury.gov/press-center/press-releases/Pages/jl2152.aspx.

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