Individual Mandate Exemptions Finalized

Margaret Dick Tocknell, for HealthLeaders Media , June 28, 2013

The 139-page regulation, which was released without fanfare, is largely a reflection of the proposed rule released in February. It confirms that individuals who cannot afford health insurance will not be subject to the penalty payment. It also clarifies an exemption from the penalty for people who live in states that have opted not to expand their Medicaid coverage.

The rule details nine categories of exemptions, including:

  • People who lack access to available plans on the state health exchanges
  • People who have experienced hardships in their efforts to obtain health insurance
  • Members of certain religious groups
  • Members of healthcare sharing ministries
  • Incarcerated individuals
  • Undocumented immigrants
  • Low income individuals who can't afford coverage
  • Individuals with coverage gaps of up to three months
  • Native Americans eligible for care through the Indian Health Service

The final rule broadens the exemptions for American Indians to include individuals who are eligible to received medical care through the federal Indian Health Service. The Associated Press recently reported that PPACA exempted only American Indians and Alaska Natives who are members of the more than 500 tribes recognized by the U.S. Bureau of Indian Affairs. This final rule will also include the more than 100 tribes that are recognized by states only.

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