Centers for Medicare & Medicaid Services: Proposed Rule Defining Essential Minimum Coverage and Exemptions

The Centers for Medicare and Medicaid Services have issued a proposed rule defining the requirements for and exemptions from the minimum essential coverage required for all individuals under the Patient Protection and Affordable Care Act (ACA)(the so-called “individual mandate”.)  This provision of the ACA was upheld in June 2012 by the U.S. Supreme Court as constitutional under the federal government’s taxing authority.

The proposed rule also details the statutory exemptions for individuals with other health insurance coverage (such as members of American Indian tribes, individuals with religious objections to health insurance, incarcerated individuals, individuals who have non-resident immigration statuses or are “not lawfully present in the U.S.”, and individuals for whom “affordable coverage” is not available.   There also are exemptions for hardship and short gaps (less than 3 months) in coverage.

Some of these exemptions may be issued by state or federally-facilitiated health insurance marketplaces but exemptions may also be self-attested by individuals.

Comments on the proposed rule are due by March 18, 2013.

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