The ACA Individual Mandate

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The ACA Individual Mandate

  1. 1. Individual Mandate Under the Affordable Care Act Dianne De La Mare, AHCA, VP Legal Affairs September 15, 2012
  2. 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. 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. 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. 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. 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. 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. 8. Questions? Email your questions to us at insurancecoverage@ahca.org

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