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The Wagner Law Group Description 

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 


Established in 1996, The Wagner Law Group has 23 attorneys engaged exclusively in employee benefits, estate planning and employment law. Seven of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.



Contact Info

The Wagner Law Group


  Integrity | Excellence


Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

Florida Office 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418


San Francisco Office

Tel: (415) 625-0002

Fax: (415) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104





September 12, 2013 

 State and Federal Law Alert


Final Individual Shared Responsibility

Rules Issued


The IRS has finalized its regulations on the individual shared responsibility provisions contained in the Patient Protection and Affordable Care Act ("PPACA"). Despite the delay, until 2015, for the employer shared responsibility penalties, the individual shared responsibility provisions, and penalties, will be effective for 2014. Under these provisions, all individuals (with certain limited exceptions-see the Alert of 2/14/13) must either be insured by "minimum essential coverage" or pay a penalty on their federal tax returns.


The final regulations make only minor changes to the proposed regulations that were issued earlier this year.


Minimum Essential Coverage. For purposes of the shared responsibility penalty, an individual is considered to have minimum essential coverage for any month in which he or she is enrolled in one of the following types of coverage for at least one day: 

  • Employer-sponsored coverage (including COBRA and retiree coverage);
  • Coverage purchased in the individual market; or
  • Government-sponsored coverage, such as Medicare, Medicaid, the Children's Health Insurance Program, or TRICARE.

 Under the final regulations, employer-sponsored coverage includes plans offered "on behalf of employers" such as multiemployer plans or plans offered by a third party such as a professional employer organization.


The final regulations do not address arrangements in which an employer provides subsidies or funds a pre-tax arrangement for employees to use to obtain coverage in the individual market. According to IRS, "it is anticipated that future guidance will address the application" of the regulations to these types of arrangements.


Minimum essential coverage does not include specialized coverage such as vision care or dental care, workers' compensation, disability policies, or coverage for a specific disease or condition. The final regulations state that certain limited TRICARE programs are also excluded from the definition of minimum essential coverage and that more details will be provided under future regulations.


Calculating Shared Responsibility Penalty. The penalty is the greater of a flat dollar amount or a specific percentage of income. For 2014, the penalty amount will be the greater of $95 per adult and $47.50 per child under age 18 (maximum of $285 per family) or 1% of income over the tax-filing threshold (currently, $19,500 for a 2012 joint return).


The preamble to the final regulations states that a taxpayer will be liable for the penalty imposed on his or her dependent, regardless whether the taxpayer actually claims the individual as a dependent or whether another person is legally obligated to provide the child's health care coverage. However, HHS may grant a hardship exemption if the child is ineligible for Medicaid or CHIP.


The 2014 shared responsibility penalties are payable when individuals file their 2014 federal income tax returns in 2015. If the penalty applies for less than a full calendar year, it is prorated to 1/12 of the annual penalty for each month without coverage.


This Newsletter is protected by copyright. Material appearing herein may be reproduced with appropriate credit.


Pursuant to Internal Revenue Service Circular 230, we hereby inform you that any advice set forth herein with respect to US federal tax issues is not intended or written by The Wagner Law Group to be used and cannot be used, by you or any taxpayer, for the purpose of avoiding penalties that may be imposed on you or any other person under the Internal Revenue Code.


This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.