Will you have to pay an Obamacare fine?

January 23, 2015, 12:25 AM UTC
Doctors Seek Higher Fees From Health Insurers
BERLIN, GERMANY - SEPTEMBER 05: A doctor holds a stethoscope on September 5, 2012 in Berlin, Germany. Doctors in the country are demanding higher payments from health insurance companies (Krankenkassen). Over 20 doctors' associations are expected to hold a vote this week over possible strikes and temporary closings of their practices if assurances that a requested additional annual increase of 3.5 billion euros (4,390,475,550 USD) in payments are not provided. The Kassenaerztlichen Bundesvereinigung (KBV), the National Association of Statutory Health Insurance Physicians, unexpectedly broke off talks with the health insurance companies on Monday. (Photo by Adam Berry/Getty Images)
Photograph by Adam Berry — Getty Images

This post is in partnership with Entrepreneur. The article below was originally published at Entrepreneur.com.

By Tom Tauli, Entrepreneur.com

If you are self-employed, and/or have fewer than 100 employees, you will not have to provide your employees health insurance. But there is a key part of Obamacare that will likely impact your pocketbook: the individual mandate. This means that you must get qualified health insurance for your family or pay an annual penalty (the law calls this the “individual shared responsibility payment”).

OK, what does it amount to? For the current year, the penalty is the greater of $95 per adult and $47.50 per child, limited to a family maximum of $285; or 1 percent of your household income above your tax filing threshold (this is the amount for determining if you must file a tax return).

But the total penalty is capped at the national average for a bronze plan, which is roughly $2,448 per person with a maximum of $12,240 for a family with five or more members.

Kind of confusing? Well, to get a better idea of how this works, let’s take an example: Suppose you are married and have two children. Your household income is $70,000 and the filing threshold is $20,300.

  • 2 adults X $95 + 2 children X $47.50 = $285
  • $49,700 (the $70,000 household income – $20,300 filing threshold) X 1% = $497
    1% X $49,700 = $497

You will have to pay $497 since it is the higher amount (you can also check out this Obamacare calculator). You will list the penalty amount on your 1040 form.

Now, if you do not pay it, the IRS will not have the typical collection powers, such as with placing liens on your home or other property. However, the agency can deduct the penalty from any tax refunds.

If you do not get qualified insurance for 2015, then the penalty will be even steeper. It will be the greater of $325 per adult and $162.50 per child, limited to a family maximum of $975; or 2 percent of household income.

There are exceptions to the penalty. Some of the notable ones include:

  • You are already covered by a qualified employer plan.
  • You have coverage from a qualified off-exchange plan.
  • You have coverage under Medicare, Medicaid, The Children’s Health Insurance Program (CHIP), TRICARE (insurance for active members in the military) or Veterans Administration plans.
  • You are a member of a qualified Native American tribe.
  • Your income is too low for the filing of a tax return.
  • You qualify for a hardship exemption (this is broad, covering situations such as bankruptcy, foreclosure, eviction, homelessness, shut off from a utility, fire/flood, a victim of domestic violence and so on).

For many of these exemptions, you will need to apply for approval with the marketplace. This can take a month or two.

If you get an exemption, you will then receive an exemption certificate number or ECN. You include this on your tax return with form 8965.

But if an exemption does not apply and you do not get qualified health insurance, then you will be completely on the hook for your medical bills. Unfortunately, this could mean facing bankruptcy if you have a catastrophic medical event (although there are some limited health insurance policies that can potentially help). Besides, Obamacare does provide for subsidies that can greatly reduce the monthly premium payments on an insurance plan.

So if anything, it’s a good idea to check out the options from your state exchange or Healthcare.gov (if you state does not have an exchange). But you will have until Feb. 15 to enroll in a plan.