Obamacare and you: Who is exempt from Obamacare?

Under Obamacare, Americans will be required to purchase health insurance for 2014, but like many requirements in life, the 'individual mandate' is not absolute. Here are the exceptions.

Rich Pedroncelli/AP
Cinthia Orozco gets help signing up for health insurance from Griselda Zamora, a health care specialist at a health fair in Sacramento, Calif., Nov. 9, 2013.

The Affordable Care Act (ACA) requires Americans to purchase health insurance. This “individual mandate” is perhaps the keystone of President Obama’s signature health-care reform law, which is also known as Obamacare.

Among other things, the mandate is intended to help spread the cost of providing care to those who need it by drawing more healthy and young people into the insurance risk pool. Those without coverage in 2014 will have to pay a penalty on their tax return for the year of 1 percent of their income or $95, whichever is greater.

But like many requirements in life, this one is not absolute. There are exceptions to the individual mandate rule.

First off, the federal government says it will not force you to buy health insurance if you really can’t afford it. The specific regulation here is that you’re exempt from Obamacare if the lowest-priced “bronze” plan you can buy through the new state exchange marketplaces would cost more than 8 percent of your household income.

You’re also exempt if your income is so low that you don’t have to file a tax return. The cutoff for that in 2013 is $10,000 for an individual or $20,000 for a couple.

If you qualify for Medicaid, but you live in a state that has chosen not to expand Medicaid with federal ACA money, you’re exempt.

You’re exempt if you are a member of a federally recognized Indian tribe or are eligible for coverage by the existing US Indian Health Service.

You’re exempt if you are serving time in jail and aren’t just awaiting trial. You’re exempt if you’re an undocumented immigrant, because such immigrants are not eligible for Obamacare subsidies.

Members of a recognized health-sharing ministry are exempt. (A health-sharing ministry is an arrangement where people of similar and sincerely held beliefs pool resources to pay for everyone’s care.)

Members of some religions are exempt. However, these religions must reject all forms of insurance, including Social Security and Medicare. This applies primarily to the Amish and some Mennonites. (Christian Scientists are not exempt.)

If you’re uncovered by health insurance for only three months or less, you won’t have to pay a tax penalty in 2014.

Finally, the Department of Health and Human Services has established a general category of “hardship exemptions.” You qualify for this if you are homeless or facing eviction, or have filed for bankruptcy within the past six months, or have incurred substantial damage from a natural disaster, for example. You can see the government’s full list here.

Some Republicans have charged that the administration has exempted some “1,200 groups" from Obamacare. Rep. Steve Scalise (R) of Louisiana said this on CNN on Oct. 15, for instance.

Strictly speaking, this isn’t true, according to Washington Post fact-checker Glenn Kessler. The charge is derived from the fact that the administration has exempted for 2014 1,231 companies and other organizations from Obamacare’s requirement that health insurance provided to workers can’t have an annual cap on benefits.

Got that? “Scalise’s use of the word ‘exempted’ is much too expansive,” Mr. Kessler writes. “He gives the impression that vast segments of politically connected ‘groups’ have been excused from the health care law when in fact he is mostly referring to a one-year waiver that was intended to make the transition to the new system easier for people with bare-bones insurance.”

of stories this month > Get unlimited stories
You've read  of  free articles. Subscribe to continue.

Unlimited digital access $11/month.

Get unlimited Monitor journalism.