Download 2017 health coverage exemption forms

To fill out a 2017 health coverage exemption application, you’ll need to download it onto your computer first.

Step 1: Identify the correct form for you

  • Right-click this exemption application form (PDF) link for hardship exemptions, like homelessness, bankruptcy, eviction, or foreclosure.
  • Right-click this exemption application form (PDF) for affordability exemptions AND residency in:
    • Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming
  • Right-click this exemption application form (PDF) for affordability exemptions AND residency in:
    • California, Colorado, District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, New York, 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…"
    • 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 3: Open the form and fill it out

When you’re ready to fill out the exemption application:

  • 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

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:

More Answers: Download 2017 health coverage exemption forms

What if I’m having trouble downloading the form?

Double-check you’re following the download instructions for your web browser. You need to save the file to your computer before you can open it. If you’re still having trouble, contact the Marketplace Call Center.

I may not have the right Adobe Reader software to download the form. What should I do?

First, make sure you right-click the PDF to download and save it to your computer. Don’t left-click.

If you right-click and are still having trouble, you may need to install the most recent version of Adobe Reader software on your computer. It’s free.

If you verified you right-clicked and your Adobe is up-to-date, contact the Marketplace Call Center.