The fine in 2014 and beyond

The penalty in 2014 is calculated one of 2 ways. You’ll pay whichever of these amounts is higher:

• 1% of your yearly household income. (Only the amount of income above the tax filing threshold, $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average yearly premium for a bronze plan.
• $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

The way the penalty is calculated, a single adult with household income below $19,650 would pay the $95 flat rate. A single adult with household income above $19,650 would pay an amount based on the 1 percent rate. (If income is below $10,150, no penalty is owed.)

The penalty increases every year. In 2015 it’s 2% of income or $325 per person. In 2016 and later years it’s 2.5% of income or $695 per person. After that it’s adjusted for inflation.

If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you’re uninsured for less than 3 months, you don’t have to make a payment.

Learn more about the individual shared responsibility payment from the Internal Revenue Service.

Enroll by March 31, 2014 and you won’t have to make the individual shared responsibility payment

If you enroll in a health insurance plan through the Marketplace by March 31, 2014, you won’t have to make the payment for any month before your coverage began.

For example, if you enroll in a Marketplace plan on March 31 your coverage begins on May 1. If you didn’t have coverage earlier in the year, you won’t have to pay a fine for any of the previous months of 2014.

If you pay the fine, you’re not covered

It’s important to remember that someone who pays the penalty doesn’t have any health insurance coverage. They still will be responsible for 100% of the cost of their medical care.

After open enrollment ends on March 31, 2014, they won’t be able to get health coverage through the Marketplace until the next annual enrollment period, unless they have a qualifying life event. Learn more about qualifying for coverage outside Open Enrollment.

Minimum essential coverage

To avoid the penalty you need insurance that qualifies as minimum essential coverage. If you’re covered by any of the following in 2014, you’re considered covered and don’t have to pay a penalty:

• Any Marketplace plan, or any individual insurance plan you already have
• Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
• Medicare
• Medicaid
• The Children’s Health Insurance Program (CHIP)
• TRICARE (for current service members and military retirees, their families, and survivors)
• Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
• Peace Corps Volunteer plans
• Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014