Individual Mandate – What you need to know

Source: photospin

Source: photospin

The Obama administration announced final regulations implementing the requirement that most Americans have health insurance coverage by Jan. 1 or pay a fine. When filing 2014 taxes in 2015, individuals must indicate on their returns if they have health insurance coverage and, if not, pay a fine. The individual penalty is the greater of $95 or 1 percent of income, rising to the greater of $695 or 2.5 percent of income, in 2016. The Congressional Budget Office estimates that less than 2 percent of Americans who don’t have health insurance will pay the fine.

The regulations specify nine categories of individuals who are exempt from the mandate:

  1. Religious conscience: You are a member of a religious sect that is recognized as conscientiously opposed to accepting any insurance benefits. The Social Security Administration administers the process for recognizing these sects according to the criteria in the law.
  2. Health care sharing ministry: You are a member of a recognized health care sharing ministry.
  3. Indian tribes: You are a member of a federally recognized Indian tribe.
  4. No filing requirement: Your household income is below the minimum threshold for filing a tax return. The requirement to file a federal tax return depends on your filing status, age, and types and amounts of income. To find out if you are required to file a federal tax return, use the IRS Interactive Tax Assistant (ITA).
  5. Short coverage gap: You went without coverage for less than three consecutive months during the year.
  6. Hardship: A Health Insurance Marketplace, also known as an Affordable Insurance Exchange, has certified that you have suffered a hardship that makes you unable to obtain coverage.
  7. Unaffordable coverage options: You can’t afford coverage because the minimum amount you must pay for the premiums is more than eight percent of your household income.
  8. Incarceration: You are in a jail, prison, or similar penal institution or correctional facility after the disposition of charges against you.
  9. Not lawfully present: You are neither a U.S. citizen, a U.S. national, nor an alien lawfully present in the U.S.

You can view a fact sheet summarizing the final regulation here.

You can view the final regulation in its entirety here.

You can find a Q&A on the Individual Shared Responsibility Provision here.


A Limit on Consumer Costs Is Delayed in Health Care Law

Source: photospin

Source: photospin


A little publicized delay in one of the key affordability provisions of the ACA has recently been discovered. The Obama administration delayed the provision for 1 year that would place a limit on out-of-pocket costs, including deductibles and co-payments. The limit on out of pocket costs was not supposed to exceed $6,350 for an individual and $12,700 for a family. This delay in implementation was posted on an administrative website in February and was not formally announced, at least until it was discovered by the media. This delay means that insurers can continue (as current practice) to set higher limits or no limits compared to those outlined in the law. The implication of this delay could be felt most by patients that require surgery or have chronic diseases.

Read the NY Times story here.

States Use Out-Of-The-Box Approaches To Raise Awareness Of Health Exchanges

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With the impending launch of health insurance marketplaces in October, several states that opted to run their own marketplace are launching innovative advertising and outreach efforts. The launch of these marketplaces may be one of the biggest (in terms of expenditures) public outreach campaigns we have seen in decades.

Read this story which provides a summary and links to various outreach strategies.

Health Law Adds New Expense For Farmers


Source: photospin


There is very serious concern about the Affordable Care Act, especially among businesses. Many employers are trying to estimate the impact the law’s mandate that employers provide coverage to full time employees will have on their bottom line. Likely, the effect will vary depending on the specific situation of each business, in particular the type of workers and the typical profit margin of the business. One of the best examples of business impact may be agriculture, which typically has slim profit margins and a need for full time workers.

The following story covers this issue and you can access it here.

Four companies to compete for the uninsured in Nebraska


Source: Photospin via Lincoln Journal Star

The federally run health insurance marketplace that will begin operation October 1 in Nebraska will likely have at least 4 insurers. The companies are Blue Cross and Blue Shield of Nebraska, which already has the biggest share of the state’s health insurance market; Coventry Health Care of Bethesda, Md., which already competes in Nebraska; CoOportunity, the cooperative health care provider in Iowa and Nebraska that was created with financing from the federal government; and Health Alliance Midwest Inc., a managed care company from Urbana, Ill.

Read more about this story here