Covered California Individual Shared Responsibility FAQ

Covered California guidance for Certified Insurance Agents helping clients with 2016 federal income tax questions.

Questions Concerning the ACA Individual Mandate

The ACA requires everyone have Minimum Essential Coverage to comply with the law and avoid a Shared Responsibility Payment (also known as tax penalty, fee, or Individual Mandate payment). If a consumer 1) does not qualify for an exemption and 2) fails to have Minimum Essential Coverage, they will have a Shared Responsibility Payment due at tax time for the months the consumer did not have coverage or an exemption.

Frequently Asked Questions:

What if my consumer has questions about the requirement to have minimum essential health benefits, or their responsibilities because of the new White House administration?

The Affordable Care Act is still a federal law and will continue to be enforced until legislative or regulatory changes are made.

What if my consumer is confused about reporting their shared responsibility requirement on their tax return?

Tax filing provisions of the Affordable Care Act continue to be enforced until legislative or regulatory changes are made. Line 61 on the Tax Form 1040 will not impact the IRS acceptance or rejection of the filing of a tax return; however, if the consumer does not check the box at line 61, the IRS may contact the consumer for more information. See Appendix A for location of line 61 on Tax Form 1040.

What if my consumer thinks they qualify for an exemption?

Covered California does not determine exemptions. Exemption applications are available from the federal government. For more information and links to the application, visit www.healthcare.gov/exemptions or call the federal marketplace at 800.318.2596.

What if my consumer has questions about the tax penalty amount and how it’s calculated?

Please visit the Tax Penalty Details and Exemptions page on Covered California’s website for more information. The IRS provides an Individual Shared Responsibility Tax Penalty estimate tool the consumer can use to estimate their potential shared responsibility payment.