1. Individual Mandate Under
the Affordable Care Act
Dianne De La Mare, AHCA, VP Legal Affairs
September 15, 2012

2. Agenda
 What is the individual mandate?
 What happens if individuals don’t comply with the
individual mandate? Are there penalties?
 Why is understanding the individual mandate important
for LTC providers?

3. What is the individual
mandate?
 Beginning 2014, legal residents of the US will be required to
have at least “minimum essential coverage” for themselves and
their dependents or pay a fine.
 Minimum coverage includes:
 Coverage under government sponsored programs;
 Employer-sponsored plans;
 Plans in the individual market;
 Grandfathered health plans; and
 Any other health benefits coverage.

4. Penalties
 The penalty will be calculated as the greater of:
 For 2014, $95 per uninsured person or 1% of the
household income over the filing threshold;
 For 2015, $325 per uninsured person or 2% of
household income over the filing amount; or
 For 2016, $695 per uninsured person or 2/5% of
household income over the filing threshold.

5. No penalties for some
individuals
 A penalty will not be assessed on individuals who:
 Have a religious exemption;
 Are not lawfully living in the US;
 Are incarcerated;
 Cannot afford coverage;
 Are in a hardship situation;
 Have an income below the tax filing threshold;
 Were uninsured for less than 3 months;
 Are members of Indian tribes;
 Are qualifying individuals who would otherwise be subject to the
mandate; but are residing outside the US; or
 Are residents in any US territory.

6. Why is understanding the individual
mandate important for LTC
providers?
 LTC providers should consider the individual mandate
requirements for both their staff and their residents.
 In particular, providers (with 50 or more employee
equivalents) must understand the obligations they now
have to offer their full-time employees health care
coverage that meets both minimum value and affordability
standards or pay a fine.

7. Resources
 Individual Mandate and Related Information Requirements
under ACA (as of 7/2/12)
 http://www.fas.org/sgp/crs/misc/R41331.pdf
 Individual Mandate and Related Information Requirements
under PPACA (as of 8/22/11)
 http://healthreformgps.org/wp-
content/uploads/CRSreportonPPACAug2011.pdf

8. Questions?
 Email your questions to us at insurancecoverage@ahca.org