Download the health coverage exemption form
To fill out a health coverage exemption application, you’ll need to download it onto your computer first.
Step 1: Download the form on your computer
- Right click on this exemption application form (PDF) link.
- Chrome and Firefox users: Choose "Save Link As…"
- Internet Explorer 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 2: Open the form and fill it out
When you’re ready to fill out the exemption application:
- Minimize this web browser window
- Locate the “hardship-exemption.pdf” document you downloaded to your computer in Step 1.
- 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
You’ll need to have a recent version of Adobe Reader software installed on your computer to open the exemption application. You may already have it. You have two options:
- 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.