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