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Individual Mandate

The individual mandate is a provision within the Affordable Care Act which requires eligible residents to obtain health insurance coverage or pay a fine. With the implementation of guarantee issue health insurance for all states, many insurers feared that an influx of sick patients combined with a lack of healthy individuals would mean financial disaster for the entire system. To counteract such an event, the individual mandate was implemented in order to create a more financially sound health care system. This mandate not only requires that qualified individuals acquire health insurance, it also sets a window on when they can enroll, preventing them from only obtaining coverage once they are sick and dropping it once they no longer need it.

Enrollment Window:

  • Initial Open Enrollment Period – October 1, 2013 – March 31, 2014
  • Annual Open Enrolment Period – October 15th through December 7th

Penalties for Individual Mandate:

  • In 2014 – per uninsured individual will be $95 or 1% of the household income
  • In 2015 – per uninsured individual will be $325 or 2% of household income
  • In 2016 – per uninsured individual will be $695 or 2.5% of household income
  • For each year thereafter it will be increased according to the cost-of-living adjustment

Exceptions to the Individual Mandate:

  • Those who cannot afford the coverage as it exceeds household income requirements
  • Those who belong to exempt religious groups
  • Undocumented residents
  • Residents who are incarcerated
  • Residents living abroad
  • Members of Indian Tribes
  • Individuals who were uninsured for less than 3 months

Whether or not one agrees with the individual mandate, it is part of the law for now. That being said, our Health Exchange Quote agents are well-versed in all areas of health care reform.

Let us help you determine which health exchange plan works for you!

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Laguna Niguel, CA 92677

Telephone: (800) 366 2751


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