Exemptions from the ACA requirements and IRS payments
Under certain circumstances, you won’t have to make the individual responsibility payment. This is called an “exemption.”
You qualify for an exemption if:
- You’re uninsured for less than 3 months of the year,
- You have Medicare, Medicaid, or some VA coverages, or
- You have such low annual income that you are not required to file with the IRS: see the IRS Interactive Tax Assistant (ITA).
The first item (from the Healthcare.gov websites) seems to mean that you can go back to the USA for up to 3 months without getting health insurance.
- You also qualify for an exemption to ACA / Obamacare if you are outside the USA at least 330 days per calendar year. (330 day “physical presence” rule)
What if I go back to the USA for more than 3 months?
You must either be exempt due to insufficient annual income (under IRS exemption to filing rules: http://www.irs.gov/uac/Newsroom/Who-Should-File-a-2012-Tax-Return%3F ), or you must get qualifying health care insurance coverage.
Some travel insurance policies qualify. See the list of essential benefits** (listed below) that must be covered by qualifying insurance.
When you arrive in your US state of residency, there are special rules allowing people to sign up for insurance protection under the exchanges, even outside the open enrollment periods.
The general public’s open enrollment period for ACA health coverage in 2014 closes on March 31, 2014, and does not reopen until 2015.
What if I live outside the USA and have health care coverage in the foreign country where I live?
~ If you do not return to the USA for more than 35 days per year (36 days in leap years), then you are exempt. (passing the 330 day “physical presence” test)
~ If you return to the USA for more than 35 days per year, but you have qualifying medical insurance coverage** (from your home country) that covers treatments while in the USA, then you are exempt from ACA/Obamacare.
What are the essential benefits that a qualifying foreign health care insurance program or travel health care insurance policy must cover?
**Essential health benefits must include items and services within at least the following 10 categories:
~ Ambulatory patient services (doctor’s office visits);
~ Emergency services (ER visits);
~ Maternity and newborn care (this is waived for men, and likely for clearly post menopausal women);
~ Mental health and substance use disorder services, including behavioral health treatment;
~ Prescription drugs;
~ Rehabilitative and habilitative services and devices;
~ Laboratory services;
~ Preventive and wellness services and chronic disease management; and
~ Pediatric services, including oral and vision care.
Note that if you return to the USA for more than 3 months, your foreign health care plan must also cover these items for treatment in the USA. e.g. IMSS does not cover treatments in the USA.
I live abroad, but I want to participate in ACA / Obamacare:
According to an advanced expert on the Marketplace helpline, you must be a Resident of the state where you apply for healthcare coverage with a state exchange. There are some multi-state coverage plans (with reciprocity agreements) like the Kansas, Missouri, and Oklahoma group, but you still must be a resident of one of those states.
A specialist on the Healthcare.gov help line, who has special advanced training, researched the options for expats living abroad reports that: They can use the US addresses of family members or friends in the state that they expect to reside in, to apply for ACA / Obamacare insurance coverage in that state’s exchange program, making the application before they return to the USA.
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Readers who want more detailed information on Americans traveling or living abroad and the Affordable Care Act (ACA) / Obamacare can go here: ACA – Obamacare’s Effects on American Expats Living Abroad
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Feel free to copy while giving proper attribution: YucaLandia/Surviving Yucatan.
© Steven M. Fry
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