Under the 2010 health care reform law (known as the Affordable Care Act), individuals are required to maintain minimum essential health insurance coverage.
As explained in the preamble, today’s final regulations [PDF 303 KB] “largely finalize” rules contained in a notice of proposed rulemaking (February 1, 2013). Thus, the final regulations include guidance for maintenance of minimum essential coverage, liability for not maintaining such coverage, and definition of terms (among other items).
As further explained in a related Treasury release, the final regulations clarify rules regarding minimum essential coverage. Also, it is explained that, earlier this summer, the Department of Health and Human Services (HHS) issued final regulations [PDF 327 KB] on exemptions from the provision and on minimum essential coverage. The HHS regulations, together with today’s final regulations, explain the shared responsibility provision and set forth the eligibility rules for receiving an exemption and the process by which individuals can receive certificates of exemption.
The final regulations apply for tax years ending after December 31, 2013.
T.D. 9632 will be published in the Federal Register on Friday, August 30, 2013.
Provisions in final regulations
Under the Affordable Care Act, beginning in 2014, the individual shared responsibility provision requires individuals to have basic health insurance coverage (known as minimum essential coverage) or qualify for an exemption or, alternatively, make a shared responsibility payment when filing a federal income tax return.
Individuals will not have to make a payment if (1) coverage is unaffordable, (2) they spend less than three consecutive months without coverage, or (3) they qualify for an exemption for several other reasons, including hardship and religious beliefs.
Under the final regulations, the shared responsibility provision does not apply for individuals (1) for whom coverage is unaffordable, (2) who have other good cause for going without coverage, or (3) who are without coverage for only a short time. The regulations, thus, clarify the hardship exemption; provide rules for partial-month coverage (so that an individual is treated as having coverage for a month as long as he or she has coverage for any one day of that month); and waive payment requirements for the first part of a coverage gap spanning multiple years.
The final regulations explain that minimum essential coverage includes, at a minimum, all of the following statutory categories:
- Employer-sponsored coverage (including COBRA coverage and retiree coverage)
- Coverage purchased in the individual market
- Medicare Part A coverage
- Medicaid coverage
- Children's Health Insurance Program (CHIP) coverage
- Certain types of veterans health coverage
Minimum essential coverage also includes any additional types of coverage that are designated by HHS or situations when the sponsor of the coverage follows a process outlined in the regulations to be recognized as minimum essential coverage.
Minimum essential coverage, however, does not include certain specialized coverage, such as coverage only for vision care or dental care, workers’ compensation, or coverage only for a specific disease or condition.