What expats need to know about the Affordable Care Act

'Murica flag to represent Affordable Care Act insurance

In our latest report on the cost of health insurance, we found that the US is the single most expensive location on earth for health insurance. One of the main reasons why the US is so costly is the fact that healthcare is so expensive, meaning that people essentially need health insurance if they plan on visiting a doctor in the US. It is primarly because of this fact that the US government took steps to drastically overhaul the healthcare system in the US. The major outcome of this overhaul is the Affordable Care Act (ACA). If you are an expat considering moving to the US or will be moving there shortly, there are a number of things you need to be aware of regarding the ACA.

What exactly is the ACA?

The Affordable Care Act, officially called the Patient Protection and Affordable Care Act (PPACA), commonly referred to as ‘Obamacare‘, was enacted in 2010 with the goal of lowering the uninsured rate, increasing insurance quality and affordability, and generally decreasing the burden of healthcare costs for people in the USA.

In order to achieve this, the US government set out a number of mandates, two of the most important being aimed at insurers and individuals. For insurers, the ACA states that they must accept all applicants, cover a set list of conditions (including many pre-existing conditions), and charge the same premiums for all applicants.

For individuals, the ACA mandates that you are required to secure compliant insurance plans should you not have one provided by either your employer or a public insurance plan. Interestingly, the fact that you ACA compliant plan is proven via one’s tax returns, and should you not have the required level of coverage, you could be slapped with hefty fines.   

Who needs to secure ACA plans?

When it comes to the ACA there are two major groups who are required to secure ACA compliant plans: Individuals and companies. Where there can be some confusion around the ACA is inbound and outbound expats, and whether you are expected to secure a compliant plan or not.

The ACA mandate for companies

According to the IRS, if your company employs more than 50 people, you are required to provide ACA compliant health insurance to at least 95% of full-time employees and their dependants under the age of 26.

Should you have fewer than 50 employees, you are not actually required to provide health insurance coverage to them. Rather, it is encouraged that you do. In order to help cover the costs of health insurance for these smaller groups, the IRS does offer tax rebates and options for offsetting the cost of providing health insurance.

For more information on the ACA for employers, check out the IRS website here.

The ACA mandate for individuals and their families

Generally speaking, all individuals who pay tax in the US are required to also secure an ACA compliant plan either through their employer or through insurance marketplaces should their employer not provide health insurance coverage. This mandate also extends to spouses and dependents under the age of 26.

In other words, if you are required to submit a tax return with the IRS, then you are more than likely required to also have secured ACA compliant health insurance, or you will have to pay a fine. Of course, there are a number of exemptions, which are explained in great detail in this PDF from the Congressional Research Service. You can also visit the IRS’s ACA for individuals website, which has an interview that helps determine whether you are exempt from this mandate or not.

The ACA individual mandate and expats

Being an expat who is either going to the US or will be leaving the US for work overseas, it can be confusing as to whether or not you are required to secure an ACA compliant plan, especially due to the fact that the US has historically strict tax laws.

As an outbound expat (someone who is a US citizen, but will be leaving for work overseas), you are still legally required to have an ACA compliant plan if you live abroad for 330 days a year or less. Should you go for, say, six months and then return, you will still need a compliant plan. For those who do spend the majority of the year outside of the US (more than 330 days), you are deemed to have an ACA compliant plan, and can tick the relevant box when you file your tax return.

As an inbound expat, if you are paying taxes in the US and spend more than 35 days a year in the US, you will be required to secure a compliant plan. The key thing to stress here is that this mandate applies to US citizens, legal US residents, resident aliens and non-resident aliens required to file tax forms. Some students and diplomats are exempt from the mandate, but the vast majority of inbound expats will need a compliant insurance plan.

What happens if I don’t secure a compliant plan?

The US government officially follows what they refer to as a “play or pay” policy when it comes to the ACA and the securing of plans. If you do not secure a plan that meets the requirements set out by the government, you will be fined. Of course, in the US nothing is ever fully ‘mandatory’. You will not be arrested or deported should you not have a compliant plan, you will just have to pay the fine.

For businesses these fines are referred to by the IRS as “Employer Shared Responsibility Provisions,” and the fine will vary depending on the situation. For example, if you have over 50 full-time employees and do not offer health insurance to at least 95% of your employees you will be fined at least USD 2,000 per employee with the first 30 employees not being counted. More information on the fines can be found here.

Individuals who do not report adequate coverage will be similarly fined, or as the IRS puts it, you will be required to “Make a Shared Responsibility Payment”. The exact amount will vary based on a number of conditions, including your annual salary, dependants, etc. You can learn more about this payment here.

Can I secure a plan before I leave for the US?

As an expat heading to or leaving the US, there is a good chance you will be returning to your home country for a vacation at least once a year. Historically, if you wanted to have coverage in your home country and in the US, you would be required to have both an ACA compliant plan and an international health insurance plan primarily because many insurers who offer global health insurance plans do not meet requirements set by the ACA.

As of November 1, 2016 however, Pacific Prime is pleased to announce that we will have an international health insurance solution that offers not only worldwide coverage, but also will be ACA compliant. This plan, offered by Cigna Global, can be a great option for any expat moving to the US, as well as expats leaving the US for a position abroad.

Visit our Cigna International Health Insurance page on this exciting new plan to learn more today.

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