Do I qualify for an exemption from paying the penalty for not having health insurance?

January 16, 2014

Exemptions from the payment 

You may qualify for an exemption from the penalty if:

  • You’re uninsured for less than 3 months of the year

  • The lowest-priced coverage available to you would cost more than 8% of your household income

  • You don’t have to file a tax return because your income is too low 

  • You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider

  • You’re a member of a recognized health care sharing ministry

  • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare

  • You’re incarcerated, and not awaiting the disposition of charges against you

  • You’re not lawfully present in the United States 

 

Other exceptions to the rule: hardship exemptions

You may qualify for a “hardship” exemption, if any of these circumstances apply to you:

  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.

  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 do not 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.

 

 

How to apply for an exemption from the penalty

 

If you're applying for an exemption based on 1) coverage being unffordable 2) membership in a health care sharing ministry 3) membership in a federally recognized tribe 4) you're incarrcerated 

 

You have two options--

 

 

Note: If you get an exemption because coverage is unaffordable based on your expected income, you may see if you qualify for catastrophic coverage. It may be affordable for you compared to the Platinum, Gold, Silver or Bronze plans. Check with us to find out.

 

If you're applying for an exemtion based on 1) membership in a recognized religious sect whose members object to insurance 2) eligibility for services through an Indian health care provider 3) One of the hardships listed earlier in this post

 

 

If your income will be low enough that you will not be required to file taxes:

 

You don’t need to apply for an exemption, even if you file a return in order to get a refund of money withheld from your paycheck. You won’t have to pay the Individual Requirement penalty. 

 

 

If you have a gap in coverage of less than 3 months, or you are not lawfully present in the U.S.:

 

You don’t need to apply for an exemption. This will be handled when you file your taxes.

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