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Individual Mandate: Exchange Open Enrollment 2016

The Affordable Care Act (ACA) requires all individuals to have minimum essential coverage, qualify for an exemption, or pay a penalty.

Health insurance carriers, state and federal Marketplaces, employers sponsoring a group health plan, and certain co-ops provide options to enroll in minimum essential coverage.

ACA-compliant individual coverage is offered one-time per year by health insurers and the state and federal Marketplace. This open enrollment time is just about to begin. State and federal Marketplaces will open on November 1, 2016 offering individual health plans for 2017.

  • November 1 - first day that an individual may enroll for coverage beginning January 1, 2017
  • December 15 - last day to enroll for coverage effective January 1, 2017
  • January 31 - last day to make any changes to health plans beginning January 1

Individuals are not eligible for coverage after January 31 unless they qualify for a special enrollment period.

The penalty for not having health insurance is the greater of either a percentage of the household income or a flat fee for each household member without insurance.  The 2016 penalties are listed below (payable in 2017).

  • Household income
    • 5% of household income over filing threshold*
    • (up to a maximum of the annual premium for the national average price of a Bronze plan sold through the Marketplace)

 

  • *Filing thresholds per IRS Publication 501
Filing Status Age at end of 2015 File Threshold
Single Under 65 $10,300
Over 65 $11,850
Head of Household Under 65 $13,250
Over 65 $14,800
Married, filing jointly Under 65 (both spouses) $20,600
65 or older (one spouse) $21,850
65 or older (both spouses) $23,100
Married, filing separately Any age $23,100
Qualifying widow(er) with dependent child Under 65 $16,600
65 or older $17,850
  • Flat dollar amount
    • $695 per adult ($347.50 per child under 18) for each person in the household up to a maximum of $2,085
    • The final flat dollar fee for 2017 has not yet been posted

All fees are calculated on a monthly basis assessing the penalty as 1/12 of the annual penalty for each month an individual was without coverage.

Additional information can be found at https://www.healthcare.gov/fees/fee-for-not-being-covered/ and https://www.irs.gov/uac/about-publication-501

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