Healthcare and the Affordable Care Act (ACA)

Affordable Care Act FAQ's

The central provision of the Affordable Care Act (ACA) is the individual mandate, which requires virtually all Americans to have a medical health insurance plan that meets federal requirements or pay a tax penalty. However, as a result of a law passed by Congress and signed by the President in late 2017, the tax penalty associated with not having the mandated insurance will be zeroed out starting in 2019.

Practically, this means that although the ACA’s requirement to have the insurance remains in place, there is no longer a penalty for not having insurance. The Department of Health and Human Services (HHS) has also indicated that they will no longer process exemptions for the individual mandate.

Below are frequently asked questions about the Affordable Care Act, as well as about how it may impact those who rely on Christian Science health care services.

How do I know if I need to purchase a health insurance plan?

Some individuals may already have met the ACA’s insurance requirement by being enrolled in a qualifying plan, such as Medicare Part A, Medicaid, TRICARE, or a health plan offered by an employer (click here to find out more about qualifying plans). If you do not have coverage but would like it, you can find out about available plans at www.healthcare.gov. Additionally, if you opt not to carry medical health insurance, you no longer need to file an exemption to avoid the tax penalty. 

I am enrolled in Medicare Part A; do I need to purchase additional insurance to meet the ACA's individual mandate requirement?

Medicare Part A satisfies the requirement. You do not need to purchase additional insurance. Note also that there are 13 Christian Science nursing facilities throughout the U.S. that participate in Medicare. Find out more at this link.

Do high-deductible insurance plans meet the ACA's requirements?

When it comes to the ACA, some levels of high-deductible coverage will satisfy the law’s qualification standards, and some won’t. For more information about these plans (also sometimes called “catastrophic” or “self-directed” plans), follow this link.

Will Serving Christian Scientists, Inc. ("SCS") plans qualify?

We recommend that you be in touch with SCS directly about this.

What is the timeline for purchasing the required insurance?

The annual enrollment period to purchase health insurance from the federal exchange is from November 1 until December 15 of each year. To find out more, visit healthcare.gov

Do plans offered in the state exchanges cover Christian Science practitioner and/or Christian Science nursing services?

Not that we are aware of, no. 

What if I don't have qualifying coverage?

Compliance with the ACA is reported annually by filing your federal income tax return. (For instance, in early 2020 when you are filing your 2019 tax return, you will report whether or not you had qualifying coverage during the 2019 calendar year.)

As indicated on this page of healthcare.gov, starting with 2019, if you do not have health insurance you will not be required to pay a tax penalty (also known as the ‘Shared Responsibility Payment’).

Do I need to apply for an exemption from the individual mandate if I don’t have qualifying coverage?

No. The Department of Health and Human Services, (HHS) has determined that it is no longer necessary to have an exemption from the individual mandate in order to avoid the tax penalty for not having health insurance. HHS will no longer process exemption applications, with the exception of the ACA’s hardship exemption.

Is there a hardship exemption to the ACA that is relevant to those who use Christian Science care services?

It may be helpful to know that the ACA’s hardship exemption became available in 2018 for those who can’t find insurance coverage for the type of health care services they want on their state’s health insurance marketplace. This includes desired coverage of services from a Christian Science practitioner, a Christian Science nurse, and a Christian Science nursing facility. This 'specialty care' hardship exemption continues to be available for the current year and beyond, and also retroactively for up to two prior calendar years.

Having a hardship exemption is also one of the ways an individual can qualify to purchase catastrophic health insurance on the ACA health insurance marketplace. This may afford additional tax benefits to those coupling a qualifying catastrophic plan with a Health Savings Account that can be used to purchase additional forms of care, including Christian Science care.

Is there a religious conscience exemption to the ACA that I can claim?

The ACA’s religious conscience exemption does now extend to individuals to “rely solely on a religious method of healing,” as many Christian Scientists do. However, HHS is no longer accepting applications for this exemption, deeming it unnecessary to avoid the tax penalty for not having health insurance.

That said, having a religious conscience exemption that Christian Scientists could qualify for remains important as a legal exception to the requirement to have qualifying health insurance. It is important to note, too, that there is no guarantee that the penalty for not having medical insurance won’t be reinstated at some point down the road.

The ACA’s religious conscience exemption offers a helpful precedent in other respects, too. Some states have their own health insurance mandates, and we are grateful that the federal law’s religious exemption has been an influential model for them. We also expect the exemption to set a meaningful precedent for future health care policy discussions.

What was the tax penalty in 2018 for not having qualifying insurance?

Here's a chart at healthcare.gov that can help you determine more specifically what the 2018 individual penalty would have been for you. Starting in 2019, the penalty will be $0 to individuals who do not have qualifying insurance.

Additional questions? Please contact the Federal Office of the Christian Science Committee on Publication at federal@christianscience.com or (202) 296-2190.

Is there a religious exemption from the ACA's requirement to purchase health insurance?

Yes, but until the 2019 tax year, it applies only to the Amish and certain Mennonites. This is because the exemption has the following requirements:

  • The individual must be a member of a religious group whose tenets and teachings establish that its members are conscientiously opposed to receiving any insurance benefits, including Social Security and Medicare benefits.

  • The individual must waive all Social Security and Medicare benefits.

  • The religious organization must pay for the health care and disability costs of its members.

Starting with 2019 taxes, a religious conscience exemption for those who “rely solely on a religious method of healing”, as do many Christian Scientists, will be available as well. The forms and process for applying for the religious exemption in 2019 are unclear as yet, but it may be possible to apply using the existing ACA religious conscience form.

This exemption is referred to by many as “the EACH Act exemption” because it recently became law as a bipartisan legislative provision called the Equitable Access to Care and Health (EACH) Act.

Are there other ways in which someone might not have to buy the insurance OR pay the tax penalty?

Some individuals may already be enrolled in a qualifying plan, such as Medicare Part A, Medicaid, TRICARE, a health plan offered by an employer, or by joining a health care sharing ministry. This meets the law’s requirement. Additionally, there are several hardship exemptions to the individual mandate, including one that may be of particular interest to Christian Scientists.

This newly-expanded hardship exemption that is available for the current calendar year, and up to two years prior (if applying in 2019, this means the exemption is available for 2019, and retroactively for 2018 and 2017). It is not a religious exemption. Rather, it is a hardship exemption for those who can’t find insurance coverage for the type of health care services they want on their state’s health insurance marketplace. This includes desired coverage of services from a Christian Science practitioner, a Christian Science nurse, and a Christian Science nursing facility.

Applications for this exemption are submitted separately from any tax filings by using the federal government’s hardship exemption form and designating #14 as the hardship being claimed, and then briefly explaining the nature of the hardship (see paragraph above).


Additional questions? Please contact the Federal Office of the Christian Science Committee on Publication at federal@christianscience.com or (202) 296-2190.

Do the federal ACA and the Massachusetts state health care requirements exist simultaneously?

Yes. But there is no longer a tax penalty associated with the federal requirement to have medical health insurance (see information above).

Can Christian Scientists still opt out of the Massachusetts health insurance law?

At the state level, Christian Scientists in Massachusetts have the following basic options:

As has been possible to do in the past, file Form HC with the annual MA income tax return to qualify for the state's religious conscience exemption to the MA health insurance law, or

Purchase health insurance that meets the state's requirements (or pay the state's penalty for not having insurance).

At the federal level, see the information above for your current options.

Do insurance options exist that meet both federal and state requirements at once?

Yes. Insurance options do exist that meet both federal and state requirements at once. If one decides to carry medical health insurance to comply with the laws, s/he will want to speak with an insurance representative or check out the following online resources:

Health Connector: www.mahealthconnector.org/

FAQs for Massachusetts tax payers: http://www.mass.gov/dor/individuals/taxpayer-help-and-resources/health-care-reform-information/frequently-asked-questions-individuals.html#36/

Will there be a penalty if I choose not to use the Massachusetts religious exemption and decide not to carry any health insurance?

For 2019 taxes, you will be subject to only state penalties. The federal penalty is no longer being enforced. Learn more at this page of healthcare.gov.

Additional questions? Contact Kevin Ness, the Massachusetts Committee on Publication, at Massachusetts@compub.org.

Are all employers, including churches, required to provide health insurance to their employees?

The ACA’s employer mandate only applies to employers with 50 or more full-time-equivalent employees.

In response to the removal of the federal ACA tax penalty, several states have taken steps to pass their own individual medical insurance mandates, and others are considering such steps. You are welcome to contact your local state Christian Science Committee on Publication for more information relating to requirements that may exist in your state.

Do Medicare and Medicaid meet the ACA’s individual insurance requirement?

Yes. If you have Medicare Part A or Medicaid, you already meet the law’s requirement and do not need to take further steps.

What if I am eligible for Medicare but have not signed up, or am not sure whether I'm enrolled?

To learn what your options are, visit Medicare's website or your local Social Security office.

If I previously used IRS Form 4361 to opt out of Social Security/Medicare, what do I do now?

At this time, the IRS has not provided guidance on this.

What guides Christian Scientists in their views on political issues, and the church’s relations with the wider society?

The church doesn’t take political stands or dictate political or personal positions to its members. Individual members decide for themselves on matters like the ACA, for example. We understand the complexity and difficulty of the issues involved in the current health care debates and recognize that honest intentions can be found on both sides. 

Spiritual healing is a way of life for most Christian Scientists, but we certainly respect the rights and concerns of our fellow citizens who rely on medical care and wouldn’t want to impose our choices on others or interfere with anyone’s right to choose medical care. This has always been a matter of basic Golden Rule ethics in our tradition. We appreciate the good motives of doctors and other medical providers, even though we normally turn in a different direction ourselves in seeking healing.

Our perspective on the practice of spiritual healing comes from the experience of actual healing in our lives, including in many cases of serious medically-diagnosed conditions and after medical treatment was unsuccessful. We believe profoundly that God’s love and God’s will are always for healing, and also that each member is always free to do what he or she thinks best in each situation. What matters most to us isn’t dogmatic or doctrinaire, but seeing our families safe and whole and the Golden Rule lived in our families and communities.