Are individuals exempt from the individual mandate if their required contribution for coverage for the month exceeds 8% or 9.5% of their household income?

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Home »Frequently Asked Questions »Are individuals exempt from the individual mandate if their required contribution for coverage for the month exceeds 8% or 9.5% of their household income?ACA/Healthcare Reform

Are individuals exempt from the individual mandate if their required contribution for coverage for the month exceeds 8% or 9.5% of their household income?

There are two different affordability percentages – 8% and 9.5% (indexed annually). These percentages are used for different purposes.

9.5% of household income is used to determine affordability for purposes of the large employer mandate (there are safe harbors employers can use instead of household income) and eligibility for premium tax credits and cost-sharing reductions on the Exchange.

8% of household income is used to determine affordability for purposes of the individual mandate. Individuals who cannot afford coverage, meaning the individual’s required contribution for coverage for the month exceeds 8% of the individual’s household income, are exempt from the individual mandate and thus will not be subject to the penalty.

There may be a more recent answer to this question. Contact Claremont for an update.