The Individual Shared Responsibility Provision
Under the Affordable Care Act, the federal government, state governments, insurers, employers, and individuals are given shared responsibility to reform and improve the availability, quality, and affordability of health insurance coverage in the United States.
Specifically, this provision requires each individual to:
- Have minimum essential health coverage every month,
- Qualify for an exemption, or
- Make a shared responsibility payment
Minimum essential coverage means coverage under a government-sponsored program, an eligible employer-sponsored plan, a plan in the individual market, a grandfathered health plan, or other health benefits coverage.
You can get more information about what types of coverage count as minimum essential coverage at:
You may be exempt from the requirement to maintain minimum essential coverage and thus will not have to make a shared responsibility payment when you file your federal income tax return if you meet certain criteria.
You may be exempt if:
- Your income is below the filing threshold for your filing status,
- You have a gap in coverage for less than three consecutive months, or
- You qualify for an exemption for one of several other reasons, including having a hardship that prevents you from obtaining coverage or belonging to a group explicitly exempt from the requirement.
The estimator will automatically determine if you or your family members may be eligible for the short coverage gap or if your income is below the filing threshold for your filing status.
Short coverage gap means a continuous period of less than three months in which you or any of your family members are not covered under minimum essential coverage.
If you or any of your family members don't have minimum essential coverage for a continuous period of three or more months, none of the months included in the continuous period are treated as included in a short coverage gap.
If a calendar year includes more than one short coverage gap, the exemption only applies to the earliest short coverage gap.
You may be exempt from the payment if your gross income or your household income is less than your applicable minimum threshold for filing a tax return.
You can get more information on this exemption and the filing threshold from Reporting and Calculating the Payment on IRS.gov
You can get more information about what types of exemptions are available at at:
- The Taxpayer Advocate Service: Individual Shared Responsibility Provision.
- Healthcare.gov: Qualifying for an Exemption from Health Insurance.
- IRS.gov: Individual Shared Responsibility Provision - Exemptions.
If you, your spouse (if married and filing a joint return), or any of your dependents don't have minimum essential coverage and don't qualify for an exemption, you'll need to pay the shared responsibility payment for each family member that isn't covered and isn't exempt.
The payment is either a percentage of the portion of your household income that is over the filing threshold for your age (and your spouse's age if married and filing jointly) and filing status or a flat dollar amount per family member.
However, the payment is capped at the national average premium for a bronze level health plan available through the Marketplace.
You can get more information on the payment and how it is calculated at:
- The Taxpayer Advocate Service: Individual Shared Responsibility Provision FAQs.
- IRS.gov: Individual Shared Responsibility Provision - Calculating the Payment.