Healthcare and the Affordable Care Act (ACA)


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. 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. The ACA’s requirement to have the insurance will remain in place.

In addition, there is a new religious conscience exemption that goes into effect in 2019, as well as an existing hardship exemption for 2018 (also available retroactively for up to two years prior to the current calendar year), both of which are described below.

Below are frequently asked questions about the Affordable Care Act, as well as about how it may impact those who typically use 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 requirement by being enrolled in a qualifying plan, such as Medicare Part A, Medicaid, TRICARE, or a health plan offered by an employer. Additionally, there are various exemptions to the individual mandate. Find out more at

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 Christian Science nursing care at 13 Christian Science nursing facilities throughout the U.S. is reimbursable under Medicare.  

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

Some levels of high-deductible coverage will satisfy the law's qualification standards, and some won't. Check out our article on high-deductible plans and the ACA for more information.

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 enrollment period to purchase health insurance from the federal exchange for 2019 has ended. To find out more, visit or this informative article offered by a third party resource,

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 2019 when you are filing your 2018 tax return, you will report whether or not you had qualifying coverage during the 2018 calendar year.) If the requirement was not met, there is a tax penalty assessed. Starting in 2019, this penalty will cost $0.

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

Here's a tool that can help you determine more specifically what your individual penalty might be. Starting in 2019, the penalty will be zeroed out and will cost $0 to individuals who do not have qualifying insurance.

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 or (202) 296-2190.

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


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

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 have a plan that meets both the ACA and the Massachusetts law’s requirements. For more information about options available in 2019 and beyond, speak with your insurance representative or check out the following online resources:  

Health Connector:

FAQs for Massachusetts tax payers:

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

For 2018 taxes, you will be subject to both state and federal penalties, but not in their full amount. The Massachusetts Health Connector and Department of Revenue has issued a policy that prevents "penalty stacking". This policy allows the individual to pay only the federal penalty, if it is greater than the state penalty; however, if the federal penalty is less that the state penalty, the individual will pay the state the difference between the two.  

Additional questions? Contact Kevin Ness, the Massachusetts Committee on Publication, at

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.

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.