Affordable Care Act (ACA) FAQs (2024)

  • Are U.S. citizens living outside the U.S. affected by the ACA?
    • During the 2018 plan year, U.S. citizens living abroad for an entire year or at least 330 days per calendar year, are exempt from the ACA rules. If you are covered by an appropriate expatriate group plan purchased in the U.S. by your employer, you meet ACA requirements. If you do not fall into either of these categories, certain rules may apply (see below). Our plans are NOT qualifying health coverage or MINIMUM ESSENTIAL COVERAGE (MEC) that satisfies the health coverage requirement of the affordable care act. In 2018, if you didn't have minimum essential coverage, you may owe an additional payment with your taxes. Starting with the 2019 plan year (for which you'll file taxes in April 2020), the federal penalty if you do not have a qualifying MEC plan no longer applies. If you don't have coverage during 2019 or later, you don't need an exemption to avoid the penalty. This is a change to federal law, not individual state laws.

  • Are non-U.S. citizens living inside the U.S. affected by the ACA?
    • 2018 ACA rules apply if you are a permanent legal resident (green card holder) or a resident alien as defined by the IRS. Starting with the 2019 plan year, the federal penalty if you do not have a qualifying MEC plan no longer applies.

  • Does travel outside the U.S. affect a U.S. resident's obligations under the ACA?
    • No. Short-term travel outside the U.S. has no bearing on a U.S. resident's obligations under the ACA. In 2018, U.S. citizens working and living outside the States for 330 days or more in a 12-month period are not required to maintain MEC. In this instance, you are deemed to have met the individual mandate. Additionally, there is no tax penalty applicable to J1, F1, M1 visa holders and other populations that meet one of the exemption categories related to the ACA individual mandate. Starting with the 2019 plan year, the federal penalty if you do not have a qualifying MEC plan no longer applies.

  • Are non-U.S. citizens traveling inside the U.S. affected by the ACA?
    • No. Unless you are a permanent legal resident or a resident alien, you are typically exempt from ACA requirements.

  • Am I a resident or non-resident alien?
  • What ACA rules apply?
    • If you are subject to ACA rules during 2018, you are expected to meet the Individual Mandate for every 12-month period, or you will be subject to tax penalties when you file your Federal tax return. Starting with the 2019 plan year, the federal penalty if you do not have a qualifying MEC plan no longer applies.

      The EHCCA- Expatriate Health Coverage Clarification Act of 2014 generally provides that most ACA provisions do not apply to expatriate health plans covering individuals traveling to or from the United States.

  • Do plans that meet the Individual Mandate function well outside the U.S.?
    • Plans available today on https://www.healthcare.gov, online exchanges operated by certain states, as well as websites operated by health insurers and health insurance brokers are not designed for accessing care outside the U.S. and thus may expose the policy holder to significant financial risk. Click here to see examples of how patients outside the U.S. directly bear substantial costs for medical emergencies, preventive care or routine illnesses when they purchase a plan that meets the Individual Mandate.

  • Can I keep my current GeoBlue coverage without penalty?
    • In 2018, there is no tax penalty for purchasing this policy if you are outside the U.S. for the entire year or 330 days in a 12-month period. In this instance, you are deemed to have met the individual mandate. Additionally there is no tax penalty applicable to J1, F1, M1 visa holders and other populations that meet one of the exemption categories related to the ACA individual mandate. Starting with the 2019 plan year, the federal penalty if you do not have a qualifying MEC plan no longer applies.

  • How is the shared responsibility payment calculated?
    • The penalty in 2018 is calculated in one of 2 ways. You'll pay whichever of these amounts is higher:

      Under the ACA in 2018, taxpayers and their dependents who are without minimum essential coverage for one or more months in a taxable year may owe an individual shared responsibility payment when filing federal income tax returns, unless an exemption applies. The IRS individual penalty amount is capped at the cost of the national average premium for a bronze level plan available through the Marketplace. For 2018, the penalty translates to the greater of $695 per adult, $347.50 per child, with a family maximum of $2,085 or 2.5% of household income above the filing threshold. The average 2018 for a Bronze level plan: $283 monthly or $3,396 annually.

      (See filing thresholds in financial examples below)- $695 per person for the year ($347.50 per child under 18). The maximum penalty per family using this method is $2,085.

      Financial Example Individual Income: $50,000 Taxable income = $39,850 (individual income ($50,000) - taxable threshold for individual ($10,150)) Shared responsibility payment = $996.25 annually, $83.02 monthly (taxable income X 2.5%)

      Financial Example Family Income: $100,000 Taxable income = $80,000 (individual income ($100,000) - taxable threshold for couple/family ($20,000)) Shared responsibility payment = $2,000 annually, $166.67 monthly (taxable income X 2.5%)

      Note: Starting with the 2019 plan year, the federal penalty if you do not have a qualifying MEC plan no longer applies.

The information above is provided for general instructional purposes only and is not intended to be legal guidance, opinion, or serve as a substitute for advice from licensed, legal and/or tax professionals; the law and tax regulations change frequently and may vary depending on jurisdiction. All risk of loss or damage based upon this information is solely that of the User, and Company (WIS) disclaims any and all liability thereof.

Affordable Care Act (ACA) FAQs (2024)

FAQs

What is one requirement of the Affordable Care Act answers? ›

The Affordable Care Act generally requires health insurance issuers to offer all of their non-grandfathered individual market and group market plans to any eligible applicant in the state.

What is the 95% rule for ACA? ›

Employers must offer health insurance that is affordable and provides minimum value to 95% of their full-time employees and their children up to the end of the month in which they turn age 26, or be subject to penalties. This is known as the employer mandate.

What is the ACA 9.5 rule? ›

Under the ACA, people are not eligible for premium tax subsidies to purchase insurance in the Marketplace if their employer offers “affordable” health coverage. Employer plans are not considered affordable if an employee must contribute more than 9.5% of their income (adjusted for inflation) toward insurance premiums.

What is the Affordable Care Act glitch? ›

What is the ACA's 'family glitch?' The “family glitch” refers to the fact that from 2014 through 2022, when the affordability of an employer-sponsored health plan was determined, it was based on just the cost for the employee. The cost to add family members was not taken into consideration.

What is the 13 week rule for ACA? ›

To comply with the ACA and reduce penalty risk, rehires who were away from the organization for 13 weeks or less (26 weeks or less for educational organizations) in most cases should not be placed in an employer's typical waiting period prior to being offered health insurance.

What is the 50/30 rule in the Affordable Care Act? ›

Under the Shared Responsibility for Employers Regarding Health Coverage (PDF) final rule, applicable large employers (ALEs) - generally defined as employers with 50 or more full-time or full-time equivalent employees in the prior year - are required to offer to at least 95 percent of their full-time employees - ...

What is the 80 20 rule for ACA? ›

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.

What is the 3 month rule for ACA? ›

Under the monthly measurement method, an employer will not be liable for either an Section 4980H(a) or Section 4980H(b) penalty for the first three months an employee is employed if the employee meets the eligibility requirement for the plan, but is not covered because the employee is in a waiting period, so long as ...

What is the 90 day rule for the ACA? ›

90-day Waiting Period Limitation. PHS Act section 2708 provides that a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days.

What is a weakness of the Affordable Care Act? ›

The ACA has been highly controversial, despite the positive outcomes. Conservatives objected to the tax increases and higher insurance premiums needed to pay for Obamacare. Some people in the healthcare industry are critical of the additional workload and costs placed on medical providers.

Why is the Affordable Care Act failing? ›

Obamacare has increased the cost of health care and health insurance. The ACA's federal mandates and spending, including Medicaid expansion and subsidized individual plans, have drastically increased the cost of health care and health insurance. 2. Obamacare increases Americans' reliance on the federal government. …

What happens if I underestimate my income for the Affordable Care Act? ›

Repayment of Benefits: You may be required to repay the benefits you received while your income was inaccurately reported. This repayment can be a substantial financial burden, especially if the unreported income period is extensive.

What is one requirement of the Affordable Care Act for the government? ›

One provision contained in the law is known as the “individual mandate” which requires that all Americans (regardless of age) be covered by health insurance (through a group or individual plan) or pay an annual financial penalty assessed by the Internal Revenue Service, unless waived under certain limited circ*mstances ...

What is one requirement of the Affordable Care Act Quizlet? ›

Insurers must provide health insurance to any person regardless of medical history or current health.

What is one requirement of the Affordable Care Act (Apex) brainly? ›

Answer and Explanation:

The state shall ensure that necessary health benefits are provided.

What is one requirement of the Affordable Care Act that senior citizens must pay for their own health insurance if they can afford it? ›

If someone who can afford coverage does not purchase it, they may have to pay a tax penalty. This is called the shared responsibility payment and sometimes also called the "individual mandate." Some people may qualify for an exemption, but you can find more details about this by visiting Healthcare.gov.

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