Fees & exemptions

Exemptions from the fee for not having health coverage

Most people must have qualifying health coverage or pay a fee (also known as the “penalty,” “fine,” “individual shared responsibility payment,” or “individual mandate”). But if you qualify for a health coverage exemption you don’t have to pay the fee.

There are a variety of exemptions, many of which you can claim on your federal tax return. There are also hardship exemptions that you must apply for with a paper application.

Find Exemptions That May Work for You

Select the button below. We’ll ask you a few questions and show you all health coverage exemptions that may apply to you.

Health coverage exemptions, forms and instructions

Following is a list of exemptions, including hardship exemptions. For details on each exemption, including forms you need and how to apply, follow the links below.

Income-related exemptions

Health coverage-related exemptions

Group membership exemptions

Other exemptions

Hardship exemptions and forms

In addition to the exemptions above, you may qualify for a “hardship” exemption. Hardships are life situations that keep you from getting health insurance.

To claim a hardship exemption, you must fill out a paper application and mail it in to the Marketplace. For details and forms, follow the links below.

Hardships that qualify you for exemptions include:

  1. You were homeless
  2. You were evicted in the past 6 months or were facing eviction or foreclosure
  3. You received a shut-off notice from a utility company
  4. You recently experienced domestic violence
  5. You recently experienced the death of a close family member
  6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property
  7. You filed for bankruptcy in the last 6 months
  8. You had medical expenses you couldn’t pay in the last 24 months that resulted in substantial debt
  9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member
  10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you don't have the pay the penalty for the child.
  11. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace
  12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act
  13. Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable
  14. If you experienced another hardship in obtaining health insurance, use this PDF form to apply for an exemption with the Marketplace.

More details about hardship exemptions

How long hardship exemptions last

Hardship exemptions usually cover the month before the hardship, the months of the hardship, and the month after the hardship.

But in some cases the Marketplace may provide the exemption for additional months after the hardship, including up to a full calendar year.

  • For people ineligible for Medicaid only because a state hasn’t expanded Medicaid coverage, the hardship exemption will be granted for the whole calendar year.
  • For people eligible for Indian Health Services, the hardship exemption lasts as long as you remain eligible.
  • For people under 21 who are eligible for an exemption due to religious conscience, you’ll need to reapply if you remain a member when you turn 21.
What to do if you experience a hardship that’s not on the list

You may have experienced a hardship that’s not on the list of 13 specific hardships above.

If so, fill out the hardship exemption application (PDF) and select option 14 on the Step 2 page. Write in how the hardship kept you from getting health coverage.

Providing a document that supports your claim of hardship will help the Marketplace process your application more quickly.

Hardship exemptions and catastrophic coverage

If you’re granted a hardship exemption, the notice includes information on catastrophic health plans. With a hardship exemption, you can buy a catastrophic plan no matter how old you are or what your income is.

A catastrophic plan offers lower-priced coverage that mainly protects you form high medical costs if you get seriously hurt or injured.

To buy catastrophic coverage with a hardship, you’ll provide your Exemption Certificate Number (ECN) to the insurance company selling the plan.

Note: If you get a hardship exemption, you don’t have to buy a catastrophic plan. It’s just an option available to you.

If you already have an Exemption Certificate Number (ECN)

If you applied for an exemption by filling out a Marketplace exemption application, you may have an Exemption Certificate Number. If you do, you don’t need to apply again.

You’ll use your ECN to complete IRS Form 8965 when you file your federal income tax return. Learn more by downloading the documents below:

The fee if you’re unemployed

Like other Americans, you must have minimum essential coverage or pay a fee. This is true regardless of your employment status.

There are several exemptions from the fee that may apply to people who have no income or very low incomes. If you have an exemption, you don’t need to pay the fee for being uncovered.