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Texas Consumers Subject to Individual Mandate Tax

The Internal Revenue Service (IRS) and the Department of Health and Human Services (HHS) issued two sets of regulations that clarified the individual mandate requirement of the Affordable Care Act (ACA).

ACA through the individual mandate requires most individuals to have minimum essential coverage or starting on January 1, 2014 or pay a penalty. Texas consumers may qualify for an exemption from the penalty, which is now called a "shared responsibility payment," and would not be subject to the penalty or would not be required to maintain coverage.

What Constitutes Minimum Essential Coverage

Minimum essential coverage will be met if an individual is enrolled for at least one day in one of the following types of coverage:

  1. An employer-sponsored group health insurance plan
  2. An individual health insurance policy
  3. A plan sponsored by the government such as Medicare (Part A), Medicaid, Children's Health Insurance Program (CHIP), TRICARE or veterans coverage
  4. Medicare Advantage Plan
  5. Health insurance coverage provided by another country for a non-U.S. citizen
  6. Student health coverage offered through enrollment in an educational institution
  7. Risk Pool coverage as sponsored by a state government
  8. Medical assistance provided for refugees by the Administration for Children and Families
  9. Coverage for Americorp volunteers

The types of coverage listed will meet the minimum essential coverage requirements.

Tax Levied for Non-Compliance

For those individuals that do not meet the essential coverage requirements, a penalty will be triggered when their 2014 tax return is filed in 2015. The penalty will be the greater amount of either a set percentage of income or a flat dollar amount. The amount of the penalty has been established for 2014, 2015 and 2016. Beginning in 2017, the penalty charged for not maintaining essential coverage requirements will be increased based on the cost of living.

The penalties for 2014 through 2016 are as follows:

For Tax Year 2014 - The greater amount of $95 per adult and $47.50 per child under the age of 18 with a maximum $285 per family or 1% of income over the tax filing threshold. The tax filing threshold is defined as the personal exemption amount (doubled for those married filing jointly plus the standard deduction amount.

For Tax Year 2015 - The greater amount of $325 per adult and $162.50 per child under the age of 18 with a maximum $975 per family or 2% of income over the tax filing threshold.
For Tax Year 2016 - The greater amount of $695 per adult and $347.50 per child under the age of 18 with a maximum $2,085 per family or 2.5% over the tax filing threshold.
The penalty will be 1/12 of the annual amount for each month that coverage is not in force.  However, the penalty for not maintaining minimum essential coverage will not exceed the national average premium for bronze level coverage as offered by the exchange. The national average premium will be determined by the premium for an individual of the same age or for a family comprised of the same number of members at their particular ages. The penalty that is owed for either themselves, their spouses or dependents must be included in that year's tax return.

Contact Stateside to Discuss ACA Updates

The Affordable Care Act open enrollment period begins October 1, 2013.  Do you understand what that means for you and your family in terms of insurance coverage for the remainder of 2013, and into 2014? Call us anytime to learn more.

You can contact Stateside Insurance Services in whichever way is most convenient for you:
www.texasplans.com
Toll Free: (866) 444-3332
Austin Local: (512) 542-9760
Email: info@texasplans.com 
Toll Free Fax: (800) 349-2730

You can run your Exchange Health Plan Quote here to view rates and plans side by side from the major carriers...Free.

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Call (866) 444-3332 (toll free) and speak with a licensed representative regarding your coverage, subsidy and enrollment questions.

Email Stateside at info@texasplans.com with demographic information (date of birth, zip code and gender), and a proposal will be sent to you.

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