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Health Insurance & Affordable Care Act

FAQ: How Will The Individual Mandate Work?

WebMD News from Kaiser Health News

By Alvin Tran

Fri, Aug 30 2013

The federal health law's individual mandate, one of the key building blocks of the insurance overhaul, remains controversial as the October start date approaches for enrolling in new online marketplaces. Individuals who don't get insurance through work will shop for insurance on these websites for policies that will take effect in January.

The mandate, which requires most people to obtain health insurance or pay a tax penalty, survived a constitutional challenge last year in the Supreme Court but remains under attack by conservatives. In July, the Republican-led House voted to delay the mandate, although the measure is not likely to get a vote in the Democratic-controlled Senate.

Despite all that attention to the mandate, 26 percent of Americans aren't aware of the requirement or didn't think the law included it, according to a March 2013 Kaiser Family Foundation poll. 

Here are some basic questions and answers about the mandate.

Q. What is the individual mandate?

A. The individual mandate is a provision of the federal health law that requires you, your children and anyone else that you claim as a dependent on your taxes to have health insurance in 2014 or pay a penalty. That coverage can be supplied through your job, public programs such as Medicare or Medicaid, or an individual policy that you purchase. The health law is setting up online health insurance marketplaces, also known as exchanges, to help you shop for plans.

Q. Who is affected by the mandate?

A. The mandate is aimed at some of the 57 million people younger than 65 who now do not have insurance. The Congressional Budget Office estimates that in 2014 nearly three out of five Americans will have coverage through an employer-provided plan and 12 percent through Medicaid and the Children's Health Insurance Program, federal-state programs that provide insurance to lower income Americans. If you have insurance in either of those ways, you are not affected. If you are in Medicare, you also meet the requirement. 

Q. Are there any exceptions to the mandate?

A. Yes, the government has identified exemptions. Individuals who cannot afford coverage because the cost of premiums exceed 8 percent of their household income or those whose household incomes are below the minimum threshold for filing a tax return are exempt. People experiencing certain hardships, including those who would have been eligible for Medicaid under the health law's new rules but whose states chose not to expand their programs, also are exempt. 

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