Download health coverage exemption forms

Step 1: Identify the correct form for you

• Right-click this exemption application form (PDF, 1.2 MB) link for hardship exemptions, like homelessness, bankruptcy, eviction, or foreclosure.
• Right-click this exemption application form (PDF, 1.1 MB) for affordability exemptions AND residency in:
  • Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming
• Right-click this exemption application form (PDF, 1.5 MB) for affordability exemptions AND residency in:
  • California, Colorado, Idaho, Kentucky, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, Washington

Step 2: Download the form on your computer

• Download the form on your computer.
  • Chrome and Firefox users: Choose "Save Link As…"
  • Microsoft Edge users: Choose "Save Target As…"
  • Safari users: Choose "Download Linked File as…"
• Select a location on your computer to save this application — on the desktop, in your documents folder, or somewhere else it will be easy to find.
• Click Save.

Step 3: Open the form and fill it out

• Minimize this web browser window.
• Locate the exemption PDF document you downloaded to your computer in Step 2.
• Click on the document to open it. You’re ready to start filling it out.
• When you’re done filling out the form, print it and mail it to the Health Insurance Marketplace^® at the address shown on the form.

Note: You may need to download the latest Adobe Reader software

• Follow the steps above. If you don’t have the right software installed, you’ll be sent to a page telling you to download it.
• You can just download the latest version for free right now to be sure.

More Answers: Download health coverage exemption forms