Government Health Insurance Requirements that May Affect International Scholars
International scholars at MIT should be aware that they may be responsible for meeting health insurance requirements set by different government agencies under:
- The Affordable Care Act
- The Massachusetts Health Care Reform Act
- The U.S. Department of State's J-1 Exchange Visitor Program
The Affordable Care Act (ACA), also known as “Obama Care,” is a national health care law that took effect January 1, 2014. Under this law, every person who is a RESIDENT ALIEN for tax purposes is required to have health insurance that meets "minimum essential health coverage" guidelines. Minimum essential health coverage includes:
Ambulatory patient services; Emergency services; Hospitalization (such as surgery); Maternity and newborn care (care before and after the baby is born); Mental health and substance use disorder services, including behavioral health treatment; Prescription drugs; Rehabilitative and habilitative services and devices; Laboratory services; Preventative and wellness services and chronic disease management; Pediatric services.
Failure to get ACA compliant minimum essential health coverage will result in the individual being required to pay a penalty called a “shared responsibility payment” at the time of filing tax forms. More information
J-1 exchange visitors in non-student categories (such as Research Scholar/Professor/Short-term Scholar) are exempt from the ACA mandate if their federal tax residency status is NONRESIDENT ALIEN. J-1 exchange visitors are usually nonresident aliens for the first two calendar years (the year they first enter the U.S. and the following year). However, this may not be true if the exchange visitor has a previous U.S. visa history. Determining your tax residency status is rather complicated; thus, it is recommended that you use the Thomson Reuters Foreign National Tax Resource (FNTR) to confirm your tax residency status. Once you and your family members become “resident aliens” for federal tax purposes, you are required to have health insurance that meets the ACA requirements in order to avoid paying the penalty.
- International scholars who have health insurance coverage through MIT benefits (MIT Traditional Health Plan, MIT Choice) or the MIT Affiliate Health Plan meet the ACA, Massachusetts (MA), and Exchange Visitor Program (J-1) requirements. Therefore, they do not need to take any additional action and will not be subject to the tax penalty.
- International scholars who have health insurance from sources in their home countries may not meet the ACA or MA requirements. If/when these international scholars are/become residents for tax purposes, they will have to pay a penalty at the time of filing their federal tax forms. Although health insurance from foreign companies and governments may meet the J-1 requirements, the ACA is NOT likely to recognize foreign health coverage as meeting the "minimum essential coverage" guidelines.
- Residents of Massachusetts (including international scholars) who have access to affordable health insurance coverage but do not obtain and maintain it may also be subject to a penalty which will be imposed through the MA income tax return. The following websites may help you better understand MA state health insurance individual mandate: Deptartment of Revenue; Mass Health Connector.
ACA Tax Penalties (Whichever is Higher):
- 2014: 1% of your yearly income or $95 per person for the year
2015: 2% of your yearly income or $325 per person for the year
- 2016: 2.6% or your yearly income or $695 per person for the year
Options to Avoid the Tax Penalty:
- Contact the MIT Benefits Office or the Affiliate Health Plan Office (based on your eligibility) to enroll in an MIT health plan. Generally, it is only possible to make changes or enroll in a new plan during the “Open Enrollment” period; however, some exceptions may apply. It is best to consult with the Benefits Office/Affiliate Health Plan Office. Again, those who are already covered by MIT Health Plans do not need to do anything as they meet the ACA, MA, and J-1 requirements.
If you are enrolled in a health plan through MIT, you will receive Form MA 1099-HC and (U.S.) Form 1095-B/1095-C by mail between January and March of the following year. These forms show the period you (and your family members, if any) were covered by MIT health plans; this information is needed for your Federal and state tax returns.
- You may enroll in a health plan that meets the ACA requirements through the Massachusetts Health Connector (https://www.mahealthconnector.org/). It provides four levels of coverage (Platinum, Gold, Silver, and Bronze). “Platinum” plans require higher premiums but provide better coverage than “Bronze” plans. The co-insurance percentages and deductibles vary within each level.
If you are enrolled in a health plan through the Health Connector, you will receive Form 1095-A by mail between January and March of the following year. This form contains information needed for your tax returns.
Since the health insurance plans offered through the MA Health Connector were designed for U.S. citizens and permanent residents, J-1 exchange visitors will have to purchase separately any coverage required under the J-1 regulations that are not typically included in standard health plans (such as medical evacuation and repatriation coverage). ISchO has a short list of health insurance providers that provide medical evacuation and repatriation coverage separately.
Open enrollment in the Health Connector is normally from the beginning of November through the end of January of the following year for the health insurance coverage of the following year. After this date, you may be eligible only when you have certain “life events.” More information
Please also note that international scholars who do not have Blue Cross Blue Shield health plans (such as MIT Health Plans) are not eligible to use MIT Medical facilities (except Urgent Care for employees and affiliates).
U.S. Department of State J-1 Exchange Visitor Program Health Insurance Guidelines
Failure to have health insurance that meets the J-1 requirements may result not only in international scholars paying “out-of-pocket” for extremely high medical costs, but also in termination from MIT’s J-1 program. As a J-1 program sponsor, ISchO is required by the regulations to terminate a J-1 exchange visitor’s immigration status if the exchange visitor does not comply with this requirement.
Please contact ISchO if you have any questions.
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Last Updated: March 2016