IRS Logo
Print - Click this link to Print this page

Individual Shared Responsibility Provision - Minimum Essential Coverage

Español

The individual shared responsibility provision requires you and each member of your family to have qualifying health care coverage, qualify for a coverage exemption, or make an individual shared responsibility payment when you file your federal income tax return. Qualifying health care coverage is also called minimum essential coverage.

Minimum Essential Coverage Chart

Coverage Type Qualifies As Minimum Essential Coverage Doesn't Qualify As Minimum Essential Coverage

Employer-sponsored coverage:

  • Group health insurance coverage for employees under –
  • A governmental plan, such as the Federal Employees Health Benefit program
  • A plan or coverage offered in the small or large group market within a state
  • A grandfathered health plan offered in a group market
  • A self-insured group health plan for employees
  • COBRA coverage
  • Retiree coverage
  • Coverage under an expatriate health plan for employees

 

Yes

 

Individual health coverage:

  • Health insurance you purchase directly from an insurance company
  • Health insurance you purchase through the Health Insurance Marketplace
  • Health insurance provided through a student health plan
  • Catastrophic plans
  • Coverage under an expatriate health plan for non-employees such as students and missionaries
Yes  

Coverage under government-sponsored programs:

  • Medicare Part A coverage
  • Medicare Advantage plans
  • Most Medicaid coverage
  • Children’s Health Insurance Program (CHIP) coverage
  • Most types of TRICARE coverage
  • Comprehensive health care programs offered by the Department of Veterans Affairs
  • Health coverage provided to Peace Corps volunteers
  • Department of Defense Nonappropriated Fund Health Benefits Program
  • Refugee Medical Assistance
  • Coverage through a Basic Health Program (BHP) standard health plan
Yes  

Other coverage:

  • Certain foreign coverage
  • Certain coverage for business owners
  • Coverage recognized by HHS as minimum essential coverage (plans recognized as minimum essential coverage are listed at  CCIIO Programs and Initiatives - after you click on the CCIIO link, scroll down and click on the link for the list of approved plans)
Yes  

Certain coverage that may provide limited benefits:

  • Coverage consisting solely of excepted benefits, such as:
    • Stand-alone dental and vision insurance
    • Accident or disability income insurance
    • Workers' compensation insurance
  • Medicaid providing only family planning services*
  • Medicaid providing only tuberculosis-related services*
  • Medicaid providing only coverage limited to treatment of emergency medical conditions*
  • Pregnancy-related Medicaid coverage*
  • Medicaid coverage for the medically needy*
  • Section 1115 Medicaid demonstration projects*
  • Space available TRICARE coverage provided under chapter 55 of title 10 of the United States Code for individuals who are not eligible for TRICARE coverage for health services from private sector providers*
  • Line of duty TRICARE coverage provided under chapter 55 of title 10 of the United States Code*
  • AmeriCorps coverage for those serving in programs receiving AmeriCorps State and National grants
  • AfterCorps coverage purchased by returning members of the PeaceCorps

*Medicaid programs that provide limited benefits generally don’t qualify as minimum essential coverage. However, HHS will provide a hardship exemption to individuals with certain types of limited-benefit Medicaid coverage.

 

 

Yes

 

Publication 974, Premium Tax Credit, provides additional information to help you determine if your health care coverage is minimum essential coverage.  If you need information about minimum essential coverage for 2014, see the instructions for the 2014 version of Form 8965

Additional Information

If you and everyone on your tax return had health coverage for every month of the year, then you will simply check the box on Form 1040, Form 1040-A, or Form 1040-EZ.  No further action is required.

You are considered to have minimum essential coverage  for the entire month as long as you are enrolled in and entitled to receive benefits under a qualifying plan or program for at least one day during that month.

If you are otherwise not required to file a tax return, you do not need to file a return solely to report your coverage.

If you are not required to file a tax return and don’t want to file a return, you do not need to file a return solely to report your coverage. Publication 974, Premium Tax Credit, provides additional information to help you determine if your health care coverage is minimum essential coverage.

You do not need to attach documentation or proof of minimum essential coverage to your tax return. Although nothing in the IRS rules or regulations requires you to provide proof of coverage at the time you file, if you have documents that verify your minimum essential coverage, you should show them to your tax preparer. The IRS will follow its normal compliance approach to filed tax returns and may ask you to substantiate the information on your tax return. Therefore, you should keep these documents with your tax records.  Learn more about the types of documents you should keep at our Gathering Your Health Coverage Documentation page.

If you do not have minimum essential coverage and wish to obtain it through the Health Insurance Marketplace, the Marketplace has an open enrollment period each year as well as special enrollment periods for eligible taxpayers. For information about enrollment periods, which health insurance options are available to you, how to purchase health insurance coverage, and how to apply for financial assistance with the cost of insurance, visit HealthCare.gov.

 

 

Page Last Reviewed or Updated: 29-Jan-2016