Who Must Enroll? What If I Don't?

Starting in 2014, the individual mandate of the Affordable Care Act (ACA) requires most people to have some form of health insurance coverage, or pay a penalty. (See "When can I sign up?" If you have coverage through one or more of these sources, you will satisfy the mandate: 

  • Government-sponsored insurance (such as Medicare, Medicaid, the Children’s Health Insurance Program, TRICARE, the veterans health program);
  • Employer-sponsored coverage;
  • Insurance bought on your own in or outside of the marketplace; or
  • A grandfathered health plan in existence before the health reform law (March 23, 2010). 

UPDATE: The Obama Administration also announced in November that if your insurer renews an old policy that doesn’t meet the new ACA requirements, that can still satisfy the mandate for 2014. 

If you do not have coverage, the marketplace is a new place to shop for health insurance in addition to the traditional private insurance market. It also can help you determine if you are eligible for financial assistance toward your insurance costs or if you are eligible for a state government health program.

Additionally, the ACA exempts certain uninsured people from having to pay the penalty. Generally, you may qualify for an exception if:  

  • Coverage is unaffordable based on your household income;
  • You don’t earn enough income to have to file a tax return;
  • You are uninsured for less than three months in a row;  
  • You are in one of the following groups: incarcerated individuals, undocumented immigrants, American Indians and Alaskan natives, participants of a health care sharing ministry, or members of a recognized religious sect opposed to having health insurance; or 
  • You experience certain hardships preventing you from obtaining coverage. 

If you don’t qualify for one of the exemptions, and you don’t have insurance coverage next year, you will have to pay a penalty. In 2014, fines begin at $95 per adult and $47.50 per child, or 1 percent of family income, whichever is greater. The penalties then increase in 2015, and in 2016 they will be as much as $695 per adult and $347 per child, or 2.5 percent of family income, whichever is greater.

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