26 U.S.C. § 5000A
An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month.
If a taxpayer who is an applicable individual, or an applicable individual for whom the taxpayer is liable under paragraph (3), fails to meet the requirement of subsection (a) for 1 or more months, then, except as provided in subsection (e), there is hereby imposed on the taxpayer a penalty with respect to such failures in the amount determined under subsection (c).
Any penalty imposed by this section with respect to any month shall be included with a taxpayer's return under chapter 1 for the taxable year which includes such month.
If an individual with respect to whom a penalty is imposed by this section for any month-
The amount of the penalty imposed by this section on any taxpayer for any taxable year with respect to failures described in subsection (b)(1) shall be equal to the lesser of-
For purposes of paragraph (1)(A), the monthly penalty amount with respect to any taxpayer for any month during which any failure described in subsection (b)(1) occurred is an amount equal to 1/12 of the greater of the following amounts:
An amount equal to the lesser of-
An amount equal to the following percentage of the excess of the taxpayer's household income for the taxable year over the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer for the taxable year:
For purposes of paragraph (1)-
Except as provided in subparagraphs (B) and (C), the applicable dollar amount is $0.
The applicable dollar amount is $95 for 2014 and $325 for 2015.
If an applicable individual has not attained the age of 18 as of the beginning of a month, the applicable dollar amount with respect to such individual for the month shall be equal to one-half of the applicable dollar amount for the calendar year in which the month occurs.
For purposes of this section-
The family size involved with respect to any taxpayer shall be equal to the number of individuals for whom the taxpayer is allowed a deduction under section 151 (relating to allowance of deduction for personal exemptions) for the taxable year.
The term "household income" means, with respect to any taxpayer for any taxable year, an amount equal to the sum of-
The term "modified adjusted gross income" means adjusted gross income increased by-
For purposes of this section-
The term "applicable individual" means, with respect to any month, an individual other than an individual described in paragraph (2), (3), or (4).
Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that-
For purposes of this subparagraph, the term "medical health services" does not include routine dental, vision and hearing services, midwifery services, vaccinations, necessary medical services provided to children, services required by law or by a third party, and such other services as the Secretary of Health and Human Services may provide in implementing section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act.
Clause (i)(II) shall apply to an individual for months in a taxable year only if the information provided by the individual under section 1411(b)(5)(A) of such Act includes an attestation that the individual has not received medical health services during the preceding taxable year.
Such term shall not include any individual for any month if such individual is a member of a health care sharing ministry for the month.
The term "health care sharing ministry" means an organization-
Such term shall not include an individual for any month if for the month the individual is not a citizen or national of the United States or an alien lawfully present in the United States.
Such term shall not include an individual for any month if for the month the individual is incarcerated, other than incarceration pending the disposition of charges.
No penalty shall be imposed under subsection (a) with respect to-
Any applicable individual for any month if the applicable individual's required contribution (determined on an annual basis) for coverage for the month exceeds 8 percent of such individual's household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act. For purposes of applying this subparagraph, the taxpayer's household income shall be increased by any exclusion from gross income for any portion of the required contribution made through a salary reduction arrangement.
For purposes of this paragraph, the term "required contribution" means-
For purposes of subparagraph (B)(i), if an applicable individual is eligible for minimum essential coverage through an employer by reason of a relationship to an employee, the determination under subparagraph (A) shall be made by reference to 1 required contribution of the employee.
In the case of plan years beginning in any calendar year after 2014, subparagraph (A) shall be applied by substituting for "8 percent" the percentage the Secretary of Health and Human Services determines reflects the excess of the rate of premium growth between the preceding calendar year and 2013 over the rate of income growth for such period.
Any applicable individual for any month during a calendar year if the individual's household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act is less than the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
Any applicable individual for any month during which the individual is a member of an Indian tribe (as defined in section 45A(c)(6)).
Any month the last day of which occurred during a period in which the applicable individual was not covered by minimum essential coverage for a continuous period of less than 3 months.
For purposes of applying this paragraph-
The Secretary shall prescribe rules for the collection of the penalty imposed by this section in cases where continuous periods include months in more than 1 taxable year.
Any applicable individual who for any month is determined by the Secretary of Health and Human Services under section 1311(d)(4)(H) to have suffered a hardship with respect to the capability to obtain coverage under a qualified health plan.
For purposes of this section-
The term "minimum essential coverage" means any of the following:
Coverage under-
Coverage under an eligible employer-sponsored plan.
Coverage under a health plan offered in the individual market within a State.
Coverage under a grandfathered health plan.
Such other health benefits coverage, such as a State health benefits risk pool, as the Secretary of Health and Human Services, in coordination with the Secretary, recognizes for purposes of this subsection.
The term "eligible employer-sponsored plan" means, with respect to any employee, a group health plan or group health insurance coverage offered by an employer to the employee which is-
Such term shall include a grandfathered health plan described in paragraph (1)(D) offered in a group market.
The term "minimum essential coverage" shall not include health insurance coverage which consists of coverage of excepted benefits-
Any applicable individual shall be treated as having minimum essential coverage for any month-
Any term used in this section which is also used in title I of the Patient Protection and Affordable Care Act shall have the same meaning as when used in such title.
The penalty provided by this section shall be paid upon notice and demand by the Secretary, and except as provided in paragraph (2), shall be assessed and collected in the same manner as an assessable penalty under subchapter B of chapter 68.
Notwithstanding any other provision of law-
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
The Secretary shall not-
1 So in original. Probably should be followed by "the".
2 So in original. The semicolon probably should be a comma.
26 U.S.C. § 5000A
Inflation Adjusted Items for Certain YearsFor inflation adjustment of certain items in this section, see Revenue Procedures listed in a table under section 1 of this title.
EDITORIAL NOTES
REFERENCES IN TEXTThe Patient Protection and Affordable Care Act and such Act, referred to in subsecs. (d)(2)(A), (e)(1)(A), (2), and (f)(5), are Pub. L. 111-148, Mar. 23, 2010, 124 Stat. 119. Title I of the Act enacted chapter 157 of Title 42, The Public Health and Welfare, and enacted, amended, and transferred numerous other sections and notes in the Code. Sections 1311(d)(4)(H), 1411(b)(5)(A), and 1412(b)(1)(B) of the Act are classified to sections 18031(d)(4)(H), 18081(b)(5)(A), and 18082(b)(1)(B), respectively, of Title 42. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of Title 42 and Tables.The Social Security Act, referred to in subsec. (f)(1)(A)(i) to (iii), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Part A of title XVIII of the Act is classified generally to part A (§1395c et seq.) of subchapter XVIII of chapter 7 of Title 42, The Public Health and Welfare. Titles XIX and XXI of the Act are classified generally to subchapters XIX (§1396 et seq.) and XXI (§1397aa et seq.), respectively, of chapter 7 of Title 42. Section 2107(g) of the Act is classified to section 1397gg(g) of Title 42. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables. Section 2791 of the Public Health Service Act, referred to in subsec. (f)(2)(A), (3), is classified to section 300gg-91 of Title 42, The Public Health and Welfare.
AMENDMENTS2018-Subsec. (d)(2)(A). Pub. L. 115-271 amended subpar. (A) generally. Prior to amendment, text read as follows: "Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is-"(i) a member of a recognized religious sect or division thereof which is described in section 1402(g)(1), and"(ii) an adherent of established tenets or teachings of such sect or division as described in such section."Subsec. (f)(1)(A)(iii). Pub. L. 115-120 inserted "or under a qualified CHIP look-alike program (as defined in section 2107(g) of the Social Security Act)" before comma at end. 2017-Subsec. (c)(2)(B)(iii). Pub. L. 115-97, §11081(a)(1), substituted "Zero percent" for "2.5 percent". Subsec. (c)(3)(A). Pub. L. 115-97, §11081(a)(2)(A), substituted "$0" for "$695".Subsec. (c)(3)(D). Pub. L. 115-97, §11081(a)(2)(B), struck out subpar. (D). Text read as follows: "In the case of any calendar year beginning after 2016, the applicable dollar amount shall be equal to $695, increased by an amount equal to-"(i) $695, multiplied by"(ii) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year, determined by substituting 'calendar year 2015' for 'calendar year 2016' in subparagraph (A)(ii) thereof.If the amount of any increase under clause (i) is not a multiple of $50, such increase shall be rounded to the next lowest multiple of $50."Subsec. (c)(3)(D)(ii). Pub. L. 115-97, §11002(d)(1) (GG), substituted "for 'calendar year 2016' in subparagraph (A)(ii)" for "for 'calendar year 1992' in subparagraph (B)". 2010-Subsec. (b)(1). Pub. L. 111-148, §10106(b)(1), amended par. (1) generally. Prior to amendment, text read as follows: "If an applicable individual fails to meet the requirement of subsection (a) for 1 or more months during any calendar year beginning after 2013, then, except as provided in subsection (d), there is hereby imposed a penalty with respect to the individual in the amount determined under subsection (c)." Subsec. (c)(1), (2). Pub. L. 111-148, §10106(b)(2), amended pars. (1) and (2) generally. Prior to amendment pars. (1) and (2) related to the amount of and dollar limitations on penalty for failure to maintain minimum essential coverage.Subsec. (c)(2)(B). Pub. L. 111-152, §1002(a)(1)(A), inserted "the excess of" before "the taxpayer's household income" and "for the taxable year over the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer" before "for the taxable year" in introductory provisions.Subsec. (c)(2)(B)(i). Pub. L. 111-152, §1002(a)(1)(B), substituted "1.0" for "0.5". Subsec. (c)(2)(B)(ii). Pub. L. 111-152, §1002(a)(1)(C), substituted "2.0" for "1.0".Subsec. (c)(2)(B)(iii). Pub. L. 111-152, §1002(a)(1)(D), substituted "2.5" for "2.0". Subsec. (c)(3)(A). Pub. L. 111-152, §1002(a)(2)(A), substituted "$695" for "$750".Subsec. (c)(3)(B). Pub. L. 111-152, §1002(a)(2)(B), substituted "$325" for "$495". Pub. L. 111-148, §10106(b)(3), substituted "$495" for "$350". Subsec. (c)(3)(D). Pub. L. 111-152, §1002(a)(2)(C), substituted "$695" for "$750" in introductory provisions and cl. (i). Subsec. (c)(4)(B)(i), (ii). Pub. L. 111-152, §1004(a)(1)(C), substituted "modified adjusted gross" for "modified gross". Subsec. (c)(4)(C). Pub. L. 111-152, §1004(a)(2)(B), amended subpar. (C) generally. Prior to amendment, text read as follows: "The term 'modified gross income' means gross income-"(i) decreased by the amount of any deduction allowable under paragraph (1), (3), (4), or (10) of section 62(a),"(ii) increased by the amount of interest received or accrued during the taxable year which is exempt from tax imposed by this chapter, and"(iii) determined without regard to sections 911, 931, and 933."Subsec. (c)(4)(D). Pub. L. 111-152, §1002(b)(1), struck out subpar. (D). Text read as follows:"(i) IN GENERAL.-The term 'poverty line' has the meaning given that term in section 2110(c)(5) of the Social Security Act (42 U.S.C. 1397jj(c)(5))."(ii) POVERTY LINE USED.-In the case of any taxable year ending with or within a calendar year, the poverty line used shall be the most recently published poverty line as of the 1st day of such calendar year."Subsec. (d)(2)(A). Pub. L. 111-148, §10106(c), amended subpar. (A) generally. Prior to amendment, text read as follows: "Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section."Subsec. (e)(1)(C). Pub. L. 111-148, §10106(d), amended subpar. (C) generally. Prior to amendment, text read as follows: "For purposes of subparagraph (B)(i), if an applicable individual is eligible for minimum essential coverage through an employer by reason of a relationship to an employee, the determination shall be made by reference to the affordability of the coverage to the employee."Subsec. (e)(2). Pub. L. 111-152, §1002(b)(2), substituted "below filing threshold" for "under 100 percent of poverty line" in heading and "the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer." for "100 percent of the poverty line for the size of the family involved (determined in the same manner as under subsection (b)(4))." in text.Subsec. (f)(1)(A)(iv). Pub. L. 111-159, §2(a)(1), added cl. (iv) and struck out former cl. (iv) which read as follows: "the TRICARE for Life program,".Subsec. (f)(1)(A)(v). Pub. L. 111-173, §1(a), amended cl. (v) generally. Prior to amendment, cl. (v) read as follows: "the veteran's health care program under chapter 17 of title 38, United States Code,".Subsec. (f)(1)(A)(vii). Pub. L. 111-159, §2(a)(2)-(4), added cl. (vii).
STATUTORY NOTES AND RELATED SUBSIDIARIES
EFFECTIVE DATE OF 2018 AMENDMENT Pub. L. 115-271, §4003(b), Oct. 24, 2018, 132 Stat. 3960, provided that: "The amendment made by subsection (a) [amending this section] shall apply to taxable years beginning after December 31, 2018." Pub. L. 115-120, div. C, §3002(g)(2)(B), Jan. 22, 2018, 132 Stat. 35, provided that: "The amendment made by subparagraph (A) [amending this section] shall apply with respect to taxable years beginning after December 31, 2017."
EFFECTIVE DATE OF 2017 AMENDMENTAmendment by section 11002(d)(1)(GG) of Pub. L. 115-97 applicable to taxable years beginning after Dec. 31, 2017, see section 11002(e) of Pub. L. 115-97, set out as a note under section 1 of this title. Pub. L. 115-97, §11081(b), Dec. 22, 2017, 131 Stat. 2092, provided that: "The amendments made by this section [amending this section] shall apply to months beginning after December 31, 2018."
EFFECTIVE DATE OF 2010 AMENDMENT Pub. L. 111-173, §1(b), May 27, 2010, 124 Stat. 1215, provided that: "The amendment made by subsection (a) [amending this section] shall take effect as if included in section 1501(b) of the Patient Protection and Affordable Care Act [Pub. L. 111-148]." Pub. L. 111-159, §2(b), Apr. 26, 2010, 124 Stat. 1123, provided that: "The amendments made by this section [amending this section] shall take effect as if included in section 1501(b) of the Patient Protection and Affordable Care Act [Pub. L. 111-148] and shall be executed immediately after the amendments made by such section 1501(b)."
EFFECTIVE DATE Pub. L. 111-148, §1501(d), Mar. 23, 2010, 124 Stat. 249, provided that: "The amendments made by this section [enacting this section and section 18091 of Title 42, The Public Health and Welfare] shall apply to taxable years ending after December 31, 2013."
CONSTRUCTION OF 2018 AMENDMENT Pub. L. 115-271, §4003(c), Oct. 24, 2018, 132 Stat. 3960, provided that: "Nothing in the amendment made by subsection (a) [amending this section] shall preempt any State law requiring the provision of medical treatment for children, especially those who are seriously ill."
- Secretary
- The term "Secretary" means the Secretary of the Treasury or his delegate.
- State
- The term "State" shall be construed to include the District of Columbia, where such construction is necessary to carry out provisions of this title.
- fiscal year
- The term "fiscal year" means an accounting period of 12 months ending on the last day of any month other than December.
- joint return
- The term "joint return" means a single return made jointly under section 6013 by a husband and wife.
- levy
- The term "levy" includes the power of distraint and seizure by any means.
- taxable year
- The term "taxable year" means the calendar year, or the fiscal year ending during such calendar year, upon the basis of which the taxable income is computed under subtitle A. "Taxable year" means, in the case of a return made for a fractional part of a year under the provisions of subtitle A or under regulations prescribed by the Secretary, the period for which such return is made.
- taxpayer
- The term "taxpayer" means any person subject to any internal revenue tax.