Health coverage exemptions: Forms & how to apply
Health coverage exemptions, forms & how to apply
You no longer pay a tax penalty (fee) for not having health coverage. If you don’t have coverage, you don't need an exemption to avoid paying a penalty at tax time.
You need an exemption if you’re 30 or older and want to enroll in a "Catastrophic" health plan. A Catastrophic health plan offers lower-priced coverage that mainly protects you from high medical costs if you get seriously hurt or injured. Learn more about Catastrophic plans.
You must apply for an exemption to qualify. You'll need to submit an application for the exemption and get an Exemption Certificate Number (ECN) to enroll in the "Catastrophic" health plan.
If you’re under 30, you don't need an exemption to enroll in a Catastrophic plan.
There are 2 types of exemptions: Affordability and hardship.
Affordability (income-related) exemptions
You can qualify for this exemption if the lowest-priced coverage available to you, through either a Marketplace or job-based plan, would cost more than 8.09% of your household income.
How long do affordability exemptions last?
- Affordability exemptions cover months in the future and can last until the end of the calendar year.
- If you want an affordability exemption for the entire calendar year, you must request it before January 1 of that year.
- If you need this exemption for months in the past, you can apply for it when you file your tax return instead.
You can qualify for this exemption if you had a financial hardship or other circumstances that prevented you from getting health insurance.
What counts as a hardship?
- You were homeless.
- You were evicted or were facing eviction or foreclosure.
- You got a shut-off notice from a utility company.
- You experienced domestic violence.
- You experienced the death of a family member.
- You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
- You filed for bankruptcy.
- You had medical expenses you couldn’t pay that resulted in substantial debt.
- You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
- You claim a child as a tax dependent who’s been denied coverage for Medicaid or the Children’s Health Insurance Program (CHIP), and another person is required by court order to give medical support to the child.
- As a result of an eligibility appeals decision, you’re eligible for enrollment in a health plan through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a qualified health plan through the Marketplace.
- You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
- You had another hardship. If you experienced another hardship obtaining health insurance.
How long do 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, 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.
Are there exemptions if I’m unemployed?
No, there’s no exemption based only on employment status. However, you may qualify if you have any of the other hardships listed on this page.