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

IRS Releases ACA Compliance Forms

The Internal Revenue Service (IRS) has released finalized forms and instructions to help employers prepare for compliance with the new information reporting provisions under the Affordable Care Act (ACA):

  • Forms 1094-C and 1095-C will be used by large employers (generally those with 50 or more full-time employees, including full-time equivalents) to report information to the IRS and to their employees about their compliance with the employer shared responsibility provisions (“pay or play”) and the health care coverage they have offered (referred to as “section 6056 reporting“).
  • Forms 1094-B and 1095-B will be used by insurers, self-insuring employers, and other parties that provide minimum essential health coverage to report information on this coverage to the IRS and to covered individuals (referred to as “section 6055 reporting“).

As a reminder, these forms are not required to be filed for 2014. However, in preparation for the first required filing (that is, filing in 2016 for 2015), reporting entities may, if they wish, voluntarily file in 2015 for 2014 in accordance with the forms and instructions.

The New “Full” Time in 2014

from HealthReform.com:

In the face of expected major changes (namely mandates for offering coverage or penalties/fines) coming in January of 2014, some large employers are finally going on record with their thoughts about their post 2014 health reform strategies.  Take a look at the following article and video to see the honest and reasonable business reaction to some of the new employer mandate rules set to begin in January of 2014.

This is yet another unintended consequence of Health Reform and an unfortunate byproduct of the way this legislation was passed.  Employers who were accustomed to building and managing a full-time workforce will now have a financial incentive to decrease their full-time employees and increase their part-time workforce. Employees who are accustomed to (and maybe need to) work 40 hour work weeks to accommodate their lifestyle may not be able to continue to do that with one employer.  In this situation, they would still not have access to employer-provided coverage.  But, they would now need to work for 2 employers to work the appropriate hours.

This article doesn’t mention the potential impact to insurance pricing by eliminating underwriting in favor of guaranteed-issue coverage.  Older people and currently uninsurable individuals (those with existing medical conditions) will be positively impacted by new community rating rules.  However, just about everyone else will see higher average prices and have fewer coverage options.  This is obviously not the intent of the endeavor to reform healthcare.

The idea of guaranteed, unlimited healthcare for every American is difficult to oppose.  No one wants anyone who is sick to be denied the care they need to get better.  No one wants a family to suffer financially while they are dealing with a family members illness as well.  No one thinks of (or even believes they should think of) cost when a loved one is ill.  However, no one expects physicians/hospitals/device/pharmaceutical companies to work for free and no one wants  to volunteer to work for less.

This could become a BIG issue and will ultimately force another patchwork of legislation to address.