What if I Don’t Buy Health Insurance?

If you did not sign up for qualified health coverage for 2014, you could be subject to the Individual Mandate penalty on April 15, 2015.   For 2014, if you have to pay the penalty for not having coverage, the tax is the greater of a) 1% of income or b) $95 per adult plus $47.50 per child, up to a maximum of $285 per family. However, the penalty is capped at the average cost of an ACA bronze level health plan which for 2014 is $3,600 per adult plus $1,900 per child.

In 2015, if you do not have qualified health insurance, your Individual Mandate penalty will increase to $325/person or 2% of your household income which ever is higher. If you make $30,000 that penalty could be $600/person. This will rise to 2 1/2% in 2016.

The federal government provides guidelines to help you determine if you qualify for an ACA hardship exemption.  You will need to make this determination with the help of your tax preparer. You will be able to get an ACA hardship exemption form at http://marketplace.cms.gov/applications-and-forms/affordability-ffm-exemption.pdf

You will be eligible for an ACA hardship exemption if one of the following things prevented you from getting health insurance:

The cost of buying health insurance would cause you to be deprived of food, shelter, clothing, or other necessities.

  • You’re an American Indian
  • Some other circumstance legitimately prevented you from getting health insurance.
    • You’re homeless.
    • You’ve been evicted within the last six months.
    • You’re facing eviction or foreclosure.
    • You’ve gotten a shut-off notice from your utility company.
    • You’ve filed for bankruptcy within the last six months.
    • You have a lot of debt due to medical expenses from the past 24 months.
    • Caring for an ill, disabled, or aging family member unexpectedly increased your essential living expenses.
    • You recently experienced domestic violence.
    • A close family member recently died.
    • You recently had a fire, flood, or other disaster that caused substantial damage to your property.
    • You are ineligible for Medicaid only because your state didn’t expand Medicaid coverage as instructed by the Affordable Care Act. The Supreme Court ruled that states didn’t have to expand their Medicaid eligibility if they didn’t want to. If your state chose not to expand Medicaid coverage but you would have been eligible if it had expanded Medicaid, you may be eligible for a hardship exemption.
    • Your child may be eligible for a hardship exemption if someone is court-ordered to provide medical support. The person mandated to provide the medical support can’t be the same person who claims the child as a tax dependent. The child must be determined ineligible for Medicaid and the Children’s Health Insurance Plan. Lastly, the exemption is only good for the months that the medical support order is in effect.
    • You may be eligible for a hardship exemption to cover the months you didn’t have health insurance if an eligibility appeals decision made you eligible during those months.


    The information listed above is a summary of the ACA Qualified Life Events but not necessarily a full list. Please contact the Healthcare market place if you have specific questions about your personal situation. Health Plans Raleigh will not be held responsible for decisions you make as a result of this article.  We recommend that you contact the healthcare marketplace and document your conversation.