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How does the government verify that you have health insurance?

“To sum it up…”

  • Asking if you have health insurance on your tax return is one method of verification
  • The government will also collect supporting documents for further verification
  • The government might also request documents from Medicare and Medicaid if you receive coverage from either program

The individual mandate is one of the critical components of the Affordable Care Act. Essentially, the individual mandate means that everyone is required to obtain health insurance or pay a fee. Regardless of whether it is private health insurance or public health insurance, everyone must have health insurance of some form now.

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This policy has generated quite a bit of debate over whether the government should require such a thing from its citizens. In any case, one of the questions it raises is how could the government enforce this rule and verify that everyone has health insurance in line with the individual mandate.

Minimum Essential Coverage


In addition to mandating that everyone has some form of health insurance, the Affordable Care Act also added that it must meet the requirements for minimum essential coverage. Any plans purchased on the Health Insurance Marketplace are constructed to meet these requirements and thus satisfy them.

Like the Affordable Care Act, Medicare and Medicaid are public health programs. Any plans offered through these is also made to meet minimum essential coverage requirements. More recently, coverage provided by an employer was changed so it must also meet these requirements.

What is the Health Insurance Marketplace?


The health insurance marketplace was mentioned earlier, but what exactly is it? The health insurance marketplace is also called the health insurance exchange. It is the location where those who do not have health insurance can learn more about their health insurance options and also buy health insurance.

On the health insurance marketplace, one can find information relevant to eligibility for assistance in paying for premiums and lowering the out of pocket costs they must pay. It is an important source of information.

Pre-Existing Conditions


Prior to the implementation of the Affordable Care Act, pre-existing conditions were a major obstacle to many getting health insurance. Insurance companies could deny someone coverage if they had a pre-existing condition. However, now, insurance companies are no longer allowed to deny someone coverage for this reason.

Sometimes, insurance companies would take alternative action when they were considering covering someone with a pre-existing condition.

Aside from denying coverage outright, insurance companies would often charge those with pre-existing conditions more for coverage. This is also no longer permitted.

Young Adult Coverage


In addition to higher costs or denial of coverage due to pre-existing conditions, one problem that the health care industry struggled with was covering young adults. Before the Affordable Care Act, insurance companies took removing young adults from their parents’ plans as a matter of course. This left many college students and others totally uninsured.

However, now, young adults may remain on their parents’ health insurance plans up until the age of 26. This has significantly decreased the amount of uninsured young adults. Graduating from college also no longer jeopardizes a young adult’s coverage under such a plan.

Young Adults and the Affordable Care Act

As mentioned earlier, young adults can now remain on their parent’s health insurance plan until they become twenty-six years of age. This is only one benefit for them, however. The policy extends coverage to more young adults, who no longer have to be financially dependent on their parents.

Additionally, a special enrollment opportunity was offered to such young adults so they could join their parent’s health insurance plan.

Finally, this addition did not increase premiums much for their parent’s, only by roughly seven-tenths of a percent.

Access to Insurance for Young Adults


One critical step young adults and their parents can take to ensure continued coverage is to look for immediate choices regarding their health insurance. Many private health insurance companies are volunteering to give coverage to those young adults about to lose coverage on their parents’ plans. That is only one step, though.

Aside from early coverage, there will be an open enrollment period where young adults can join their parent’s health insurance plan. Also, some insurance companies will extend an offer of continued coverage so the health insurance is not interrupted at all.

Tax Incentives for Covering Young Adults


The first benefit is that if health insurance companies cover young adult past the age of twenty-six, the employees can exclude their employer-provided health care benefits from their taxable income. Those tax benefits are available to take advantage of right now. These benefits are also widely available.

The tax benefits are applied to employer-provided health insurance plans and some retiree insurance plans. Qualified self-employed people can also take advantage of this tax benefit.

Preventative Health Services and the Affordable Care Act


A majority of the available health insurance plans are required to cover certain preventative services with no out of pocket costs. Plans offered through the Health Insurance Marketplace are included with this category. Three main varieties of preventative services exist: Those for women, those for children, and those for all adults.

Screening for blood pressure, screening for depression, and vaccines are some preventative services for all adults that are covered. STD screening, contraception, and screening for gestational diabetes are some covered preventative services for women. Some preventative services for children that are covered include screening for autism, hearing tests, and vaccines.

Your Health Insurance Coverage and Verification

One method in which the federal government checks that you have health insurance coverage is via your taxes. There is a portion asking if you and your family possess health insurance coverage that you must fill out. The verification is more thorough than that, however.

Health insurance companies and employers that provide health insurance plans are also required to provide information regarding who they cover. This way, there is two layers of verification.

Carrot and Stick of the Mandate

While the mandate does require everyone to get insurance, there are also benefits offered to encourage obtaining health insurance. Some of those benefits include tax credits that are designed to assist Americans with moderate incomes afford to purchase health insurance.

Additionally, insurance companies have certain restrictions applied to them to aid in the process of getting insurance. One of those is the restriction that they cannot charge higher premiums for those with pre-existing conditions.



Medicare is one of the two major public health insurance programs available in the United States. It is an alternative to obtaining private health insurance. It is funded and operated by the federal government.

Since it is a public health insurance program, sometimes people use it to cover their medical expenses. Aside from tax verification, the federal government may obtain documents from Medicare to verify that you are covered under the program. This only applies if you get your health insurance coverage from the Medicare program, though.



Unlike Medicare, Medicaid operates in conjunction with both the federal government and the state government. It is a public health program that is constructed in order to assist certain individuals with medical costs, especially those who do not have the resources to do so themselves.

Since Medicaid is also involved with the state government, verifying that you are covered by it is a slightly different process than doing so with Medicaid. The government may ask you to list your coverage under Medicaid on your federal tax return. If not, they will request documents from Medicaid to verify your coverage.

Health Insurance Coverage and Verification


There are several methods that the federal government uses to verify that you have health insurance coverage. One of the primary methods is asking you if you have health insurance coverage on your tax return. Then, they gather documents from insurance companies and/or employers in order to verify your statements.

Aside from that, the federal government may request documents from Medicare and Medicaid. This is only the case if you participate in either public health insurance program. However, the primary method is using your tax information to determine your health insurance status.

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  1. https://healthchoiceone.com/obamacare/major-medical-before-and-after-aca/
  2. https://www.irs.gov/affordable-care-act/individuals-and-families/the-health-insurance-marketplace
  3. https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html
  4. https://www.cms.gov/CCIIO/Resources/Files/adult_child_fact_sheet.html
  5. https://www.healthcare.gov/coverage/preventive-care-benefits/
  6. http://www.insure.com/health-insurance/tax-returns-health-insurance.html
  7. https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html
  8. https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html