As a service to the public, Americans for Tax Reform has released a projected tax form to help families and tax specialists prepare for the additional filing requirement of the Affordable Care Act's individual mandate provision.

Starting in 2014, all Americans who file income tax returns must complete an additional IRS tax form. The new form requires disclosure of a taxpayer’s personal identifying health information in order to determine compliance with the Affordable Care Act’s individual mandate.  As confirmed by IRS testimony to the tax-writing House Committee on Ways and Means, “taxpayers will file their tax returns reporting their health insurance coverage, and/or making a payment”.  

You may download a PDF file of the form and instructions here or view it below. 

Highlights from the Obamacare Individual Mandate Tax Compliance Form:

1.  Determination of “qualifying” health insurance.  Under the Affordable Care Act,  most Americans must purchase health insurance deemed “qualified” by the Department of Health and Human Services  (HHS) starting in 2014.  Failure to comply with this mandate results in a tax penalty which must be paid to the IRS. The tax penalty ranges from $695 to $2085, or more, depending on the size of a family.  The dollar amount grows over time and is tabulated on the form. Taxpayers must demonstrate that they obtained qualifying health insurance for each month of the year in order to avoid payment of this tax penalty. [See lines 12-13]

2.  Disclosure of personal identifying health information.  Every family that files a tax return (140 million households) will have to disclose whether or not they were covered by a qualifying plan, in which months they were covered, and what type of coverage they received.  Tax filers must also divulge and disclose their personal health ID number, the nature of their health insurance, and other information from their health insurance card as further IRS regulations warrant.  [See lines 3-4]

3.  Exemptions from Individual Mandate: Prisoners, Undocumented Immigrants, Welfare Recipients. The form also determines which individuals are exempt from the Individual Mandate and non-compliance taxes. Classes of individuals who are exempt from the mandate include but are not limited to: those serving sentences in the federal penitentiary system; those persons not legally able to work in the U.S.; welfare recipients; and those qualifying for an HHS-granted religious exemption.  [See lines 8-11]

4.  IRS penalties and interest on unpaid mandate taxes.  Because the Affordable Care Act’s individual mandate penalty is a tax, the IRS will be able to assess interest and non-criminal penalties on those families who will not or cannot pay the tax. The IRS will issue regular, periodic correspondence audits to these families to help them comply with their filing responsibilities.