Beginning in 2014, the individual shared responsibility provision of the Affordable Care Act requires each individual to:
- Maintain a minimum level of health care coverage – known as minimum essential coverage, or
- Qualify for an exemption, or
- Make an individual shared responsibility payment when filing their federal income tax returns.
Minimum essential coverage generally includes government-sponsored programs, employer-provided health coverage, and coverage purchased in the individual market, including the Health Insurance Marketplace. Most people already have health insurance coverage that qualifies as minimum essential coverage, and therefore will not need to make a payment if they maintain their qualified coverage. However, for each month that you or a member of your family is without minimum essential coverage and does not qualify for an exemption, you will need to make an individual shared responsibility payment.
If you and your dependents had minimum essential coverage for each month of 2014, you will check a box indicating that when you file your 2014 federal income tax return. If you qualify for an exemption, you will attach a form to your tax return to claim that exemption. If you are required to make the individual shared responsibility payment, you will calculate your payment and make the payment with your return.
If you choose to make an individual shared responsibility payment instead of maintaining minimum essential coverage, this means you will not have health insurance coverage to help pay for medical expenses.
In general, the individual shared responsibility payment for 2014 is the greater of:
- One percent of your household income above the income filing threshold for your tax filing status, or
- A flat dollar amount of $95 per adult and $47.50 per child (under age 18) in your family, but no more than $285 per family.
The individual shared responsibility payment is also capped at the cost of the national average premium for bronze level health plans available through the Marketplace that would cover everyone in your family who does not have minimum essential coverage and does not qualify for an exemption – for example, $12,240 for a family of five. However this maximum fee will only impact the small number of high-income taxpayers who choose to go without health insurance. The payment amount is based on each individual’s personal circumstances; examples and information about figuring the payment can be found on our Calculating the Payment page on IRS.gov/aca.
