Will your family have to pay a tax penalty for not having health insurance? How much is the family health insurance penalty? Will it be cheaper to go without family health insurance and pay the penalty, or to buy health insurance?
A controversial part of the Affordable Care Act, the individual mandate requires Americans to have health insurance by January 1, 2014. Those who don’t have coverage face a penalty tax, the shared responsibility payment. Only a small number of Americans are exempt from the requirement to have health insurance coverage.
Each state has a health insurance exchange to help families and individuals find insurance. Subsidies are available to help low-income families afford health insurance. But, if you’re accustomed to going without insurance and don’t qualify for a subsidy, you’ll have to squeeze this new expense out of the family budget or you’ll owe the penalty tax.
How to calculate the family health insurance penalty
First, scroll down to look at the penalty table at the bottom of the page. Then come back up to learn how to use it.
The penalty your family will owe is either a fixed minimum amount or a percentage of your family’s income, whichever is larger. The percentage-of-income penalty usually hits middle-class or wealthier families. It ensures that the penalty isn't so small it's merely a nuisance. The fixed minimum penalty usually hits low-income families. It ensures everyone pays at least a minimum penalty.
Here’s how you figure out your family's penalty.
- Calculate the family’s minimum penalty.
- Calculate the family’s percentage-of-income penalty.
- Compare the two results; you’ll owe the larger of the two.
How to calculate the family’s minimum penalty
To calculate the family’s minimum penalty, add together the individual penalty amounts for each family member using the penalty for the appropriate year from the table below.
Two rules make the family’s minimum penalty smaller. The individual penalty is halved for children under 18 years old. The family’s minimum penalty is capped at three times the individual penalty.
Tom and Sandy have 3 young children. Nobody in the family has health insurance. They need to calculate the family’s minimum penalty for the year 2015.
The table shows the minimum penalty is $325 for each individual in the family. But, only the adults owe the full amount. The minimum penalty is half that amount, or $162.50, for each of the kids.
$325 (for Tom) + $325 (for Sandy) + $162.50 (for child 1) + $162.50 (for child 2) +$162.50 (for child 3) = $1,137.50 (for the family)
But, a family’s minimum penalty maxes out at three times the individual minimum penalty, or $325 x 3 = $975. Since $1,137.50 is larger than $975, they’ll use $975 for the amount of their minimum family penalty as they move forward with their calculations.
How to calculate the family’s percentage-of-income penalty
Figure the percentage-of-income penalty for the family based on the entire household’s income. From the table below, the penalty percentage for 2015 is 2% of the income above the filing threshold.
- Tip: Don't pay the government too much. Only pay the health insurance penalty on the portion of your income that's over the filing threshold. Subtract the filing threshold from your income before calculating the penalty.
- Tip: The filing threshold is the amount of income that requires you to file a tax return. People with incomes below the filing threshold don’t have to file an income tax return; those with incomes above the threshold must file.
- Tip: You can estimate the filing threshold using the 2012 figures of $9,750 for single filers, $12,500 for head-of-household filers, and $19,500 for married couples filing jointly. Or, for the most accurate results, you can get the filing threshold for the year in question from publication 501 at the IRS forms and publications page.
Tom and Sandy together will make $100,500 in 2015. They file their taxes as a married couple filing jointly, so they’ll use $19,500 as an estimate of their filing threshold, subtracting it from their income before they calculate the percentage.
$100,500 - $19,500 = $81,000
The family’s income - the filing threshold = the portion of their income to be penalized.
$81,000 x 0.02 = $1,620
The portion of income to be penalized x the 2% penalty = their percentage-of-income penalty.
- Tip: If you can’t remember how to work with percentage calculations, here’s a percentage calculator.
Pulling it all together: know what you’ll owe
Now that you’ve calculated your family’s minimum penalty and your family’s percentage-of-income penalty, you need to compare them. Your family’s shared responsibility payment will be based on the larger of those two amounts.
There are a few situations that might decrease your family’s penalty.
- Do you have a large penalty?
The penalty maxes out at the national average cost of a bronze-tier family health insurance plan for that year.
- Will your family have health insurance for part of the year?
Only pay the penalty for the months your family is uninsured. For example, if your family was uninsured for seven months of the year, you would only pay seven-twelfths of the yearly health insurance penalty.
- Can’t find affordable health insurance?
If you can’t find family health insurance that costs less than eight percent of your household income, your family may be exempt from the penalty. The eight percent figure is based on what your family has to pay for the coverage, not on the cost before employer contributions or premium subsidies.
Tom and Sandy’s minimum family penalty for 2015 was $975. Their family’s percentage-of-income penalty was $1,620. Since their percentage-of-income penalty is larger, that’s the figure their family penalty will be based on. If their family had been uninsured all year, they would owe a shared responsibility payment of $1,620.
However, Sandy switched jobs in July, and her new employer offered health insurance. The entire family was covered by health insurance starting in September. Since they were only uninsured for the first 8 months of the year, they only have to pay the penalty for the portion of the year they were without coverage.
$1,620 x 8/12 = $1080
The yearly penalty amount x the part of the year they were uninsured = the final family penalty owed.
Tom and Sandy owe a shared responsibility payment of $1080 because their family lacked health insurance coverage for 8 months of 2015. Along with their 2015 income taxes, this penalty tax is due to the IRS by April 15, 2016.
US Code 2011, Title 26, subtitle D, Chapter 48, sec5000A
IRS: Questions and Answers on the Individual Shared Responsibility Provision
Congressional Research Service report: Individual Mandate and Related Information Requirements Under the PPACA
|Year 2014||Year 2015||Year 2016||After 2016|
|income based penalty||1% of income above filing threshold||2% of income above filing threshold||2.5% of income above filing threshold||2.5% of income above filing threshold|
|minimum penalty amount||$95||$325||$695||$695 + inflation adjustment|