October 2, 2013
Updated information on how to get an exemption from ACA / Obamacare for expats living abroad who travel back to the USA:
Exemptions from the payment
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
This means that you can go back to the USA for up to 3 months without getting health insurance.
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), or you must get qualifying health care insurance coverage.
Many travel insurance policies qualify. See the list of essential benefits** (listed below) that must be covered by qualifying insurance.
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, then you are exempt.
~ If you return to the USA for more than 35 days per year, but you have qualifying medical insurance coverage** in your home country, 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.
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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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proper attribution: YucaLandia/Surviving Yucatan.
Steven M. Fry