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Understanding the Individual Mandate


Understanding the Individual Mandate

Ryan Lucht

Ryan Lucht

Associate partner at ChurchWest.
Ryan Lucht

Latest posts by Ryan Lucht (see all)

The one thing that everyone really needs to grasp is the individual mandate.  What does this mean?

Simply stated, the Individual Mandate requires that nearly all American citizens are required to get health insurance by January 1, 2014 (although there is a grace period for the first few months).  So, whether it’s through your employer, Medicare, MediCal, an individual plan, or through the exchange, you have to get coverage or risk paying a penalty.

Now, look at your current situation and then you can decide how everyone is going to get coverage.

Large Group (50 or more full time equivalent Employees):

Starting 1/1/2015, you’ll only have one option. You will have to provide group health insurance or pay a pretty hefty fine. In the meantime, this does not waive your employees’ obligation to fulfill the individual mandate. They will still need to get health insurance on their own, through their spouse, or on the exchange.  If they don’t, they’ll pay a fine.

Small Group (less than 50 full time employees):

You have a few options:

  1. Continue to offer your existing health insurance plan. (You will need to make sure that it meets minimum guidelines). You may want to make sure that you apply for the “Religious Employer Exemption” (link to landing page #1)
  2. Go to the SHOP Exchange. This is an online marketplace for small group health insurance and the only place where your church might qualify for subsidies of up to 35% of your premium. The Federal Exchange is delayed for a year; but it is available in California and we can walk you through it.
  3. Your church doesn’t have to offer group health insurance, but again, your employees will still be required to fulfill the individual mandate and get health insurance on their own, through their spouse, or on the exchange.

Individuals:

No options here. Everyone is going to need to get health insurance on an individual plan, through a spouse, on the Exchange, or pay a fine.

If we can help you out in any way, please just let us know.