Healthcare and the Affordable Care Act (ACA)

For several years, the U.S. Federal Office has been speaking with governmental offices about the federal health care reform efforts that culminated in the 2010 Patient Protection and Affordable Care Act (the ACA). While this law does not yet contain any religious accommodation or exception for Christian Scientists and others who use spiritual care services for their health, we continue to actively work towards this goal.

Health insurance information page

Third-party websites


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. For 2018, the enrollment period officially ended on December 15, 2017. 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. Find out more at

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, Medicaid, TRICARE, or a health plan offered by an employer. Additionally, there is an income-based hardship exemption to the individual mandate. You may want to check out this flowchart to help you decide whether you need to purchase insurance in order to comply with the law.

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

No. Medicare Part A satisfies the requirement. Note also that Christian Science nursing care at 17 Christian Science nursing facilities throughout the U.S. are reimbursed under Medicare Part A.  

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 2018 has ended. Options for enrollment at this time are limited, although you may qualify for a special enrollment period and some states have announced one-time extensions for enrollment for 2018 plans. To find out more, visit or this informative article offered by a third party resource,

If I don't have qualifying or any coverage and want to purchase a plan, where can I do that?

The ACA provides for each state to have an “exchange”—a health insurance marketplace where individuals and small businesses can compare and enroll in insurance plans (and find out if they are eligible for federal subsidies to purchase insurance). The marketplace has a 24/7 customer call center (800-318-2596) to answer questions.

What if my state doesn't have an exchange?

States that aren’t running their own have federal government-run exchanges. Not all states are taking the same approach, but this does not impact the requirement on individuals to purchase qualifying insurance.

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

Currently, no. Over the past several years, the U.S. Federal Office has diligently worked to secure the inclusion of Christian Science health care services in health insurance plans offered at the state insurance marketplaces. We are deeply grateful for governmental receptivity to insurance coverage of this kind.

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 2018 when you are filing your 2017 tax return, you will report whether or not you had qualifying coverage during the 2017 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 for not having qualifying insurance?

Check out how the penalty will be calculated in 2017 and 2018. 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.

Isn't there a religious exemption from the ACA's requirement to purchase health insurance?

Yes, but it applies primarily to the Amish and certain Mennonites. This is because the current 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.

That said, the U.S. Federal Office has been working Congress on potentially broadening this religious conscience exemption, though this proposed solution cannot be guaranteed at this time. 

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. Additionally, there is an income-based hardship exemption to the individual mandate. You may want to check out this online tool to help you decide whether you qualify for an exemption or need to purchase insurance to comply with the law.

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 you've been able to do in the past, file Form HC with your 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, there currently is not yet a religious exemption to the ACA for which Christian Scientists can qualify, so your basic options are to:

  • pay the penalty for not carrying the federally required level of health insurance, or
  • purchase health insurance that meets the ACA's requirements

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

Yes. Insurance options will exist that meet both federal and state requirements at once. If you decide to carry medical health insurance to comply with the laws, you will want to have a plan that meets both the ACA and the Massachusetts law’s requirements. For more information about options available in 2018 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?

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 Ingrid Peschke, 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. 

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 has the Church been doing to respond to the ACA?

Please note that these efforts are works in progress, and we will share more detailed information as it is available.

How can I help the U.S. Federal Office in these efforts?