Which Individuals Can Claim Exemptions (Including Hardships) From The Requirement to Maintain Minimum Essential Health Coverage?

 

For year 2017, individuals who meet any of the exemptions or hardships shown below are NOT required under the law to maintain minimum essential health coverage for either the full year OR specific month(s) of the year. To qualify for a full-year or partial-year exemption or hardship, you may need to file an application with the Marketplace and receive an Exemption Certificate Number (ECN) BEFORE you can file your federal income tax return! Some exemptions can be claimed directly on your tax return without filing an application with the Marketplace. See below for details. 

Exemption / Hardship How to Apply
Coverage Is Considered Unaffordable - Individuals who cannot afford coverage because the minimum required contribution amount they must pay for healthcare premiums for the lowest cost self-only coverage through an employer-sponsored plan or, if the individual does not have access to employer-sponsored coverage, the lowest cost bronze level health plan available in the Marketplace is more than 8.16% of their household income for the year

Coverage is also considered unaffordable if two or more family members' aggregate cost of self-only employer-sponsored coverage is more than 8.16% of household income, as does the cost of any available employer-sponsored coverage for the entire family
You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Short Coverage Gap - Individuals who go without coverage for LESS THAN three consecutive months* (without regard to the calendar year)

*If you have coverage for at least one day of the month, you are considered to have coverage for that ENTIRE month. When calculating a short coverage gap, the calendar year is disregarded. You need to look-back to November and December of the prior year when calculating LESS THAN three consecutive months. There is only a look-back period, which means you do not look forward into the following year. EXAMPLE 1: You had no coverage in November and December of 2016 and no coverage in January and February of 2017. This is a four month coverage gap for year 2017. EXAMPLE 2: You had no coverage in November and December 2017 and no coverage in January and February of 2018. For year 2017, you only have a two month coverage gap (November and December 2017). You do not look forward into a future year when calculating the short coverage gap. For year 2018, you have a four month coverage gap.
You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Household Income Is Below the Tax Return Filing Threshold - Individuals whose household income is below the minimum threshold for filing a federal income tax return. The requirement to file a federal tax return depends on your filing status, age and types and amounts of income. Note: Household income generally includes the income of all eligible dependents of the taxpayer if the dependent is required to file an income tax return You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Member of Tax Household Born or Adopted During the Year - For the months before and including the month an individual was added to your tax household by birth or adoption



You do not need to report. These months are automatically exempt from the penalty.
Member of Tax Household Died During the Year - For the months after the month an individual dies during the year



You do not need to report. These months are automatically exempt from the penalty.
Noncitizens - Individuals who are NOT U.S. citizens or nationals, or are in the United States illegally, or are nonresident aliens



You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Certain U.S. Citizens and Residents Living Abroad -
  • Individuals who are U.S. citizens or residents who live abroad (not physically present in the United States) for the calendar year OR at least 330 days within a consecutive 12 month period. An exemption may be claimed for any month during the tax year that is included in the consecutive 12 month period, OR
  • Individuals who are U.S. citizens AND are a bona fide resident of a foreign country (or countries) for the ENTIRE tax year, OR
  • Individuals who are U.S. citizens AND a resident of a U.S. territory
You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Members of A Recognized Health Care Sharing Ministry - In general, a health care sharing ministry is a tax-exempt organization whose members share a common set of ethical or religious beliefs and share medical expenses in accordance with those beliefs, even after a member develops a medical condition. The health care sharing ministry (or predecessor) must have been in existence and sharing medical expenses continuously and without interruption since December 31, 1999. If an individual is unsure whether the ministry meets requirements, the individual should contact the ministry for further information You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Resident of a State That Did NOT Expand Medicaid - If you were a resident of a state that did NOT expand Medicaid under the Affordable Care Act, and your household income was BELOW 138% of the federal poverty level (FPL) for your family size.

Florida is one of the states that did NOT expand Medicaid.
You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Members of Federally Recognized Indian Tribes, Alaska Native Claims Settlement Act (ANCSA) Corporation Shareholders, and People Who Are Otherwise Eligible for Services Through An Indian Health Care Provider - The list of federally recognized Indian Tribes is available by clicking here

You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Incarceration - Individuals who are incarcerated in a jail, prison, or similar penal institution or correctional facility, AFTER the disposition of charges. If the charges are pending, this exemption does NOT apply


You can only claim this exemption on your federal income tax return. Do NOT file a separate application with the Marketplace!
Members of Certain Religious Sects Whose Members Object to Health Insurance - Individuals who are members of recognized religious sects that are exempt from self-employment tax



You may ONLY claim this exemption by filing an exemption application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
Hardships
You were homeless

Documentation REQUIRED to be submitted with application: None



You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You were evicted OR were facing eviction or foreclosure

Documentation REQUIRED to be submitted with application: Copy of eviction or foreclosure notice. Must be within the last three years (2015 - 2017)

You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You received a shut-off notice from a utility company

Documentation REQUIRED to be submitted with application: Copy of a shut-off notice from a utility company that states service has or will be shut-off. Must be within the last three years (2015 - 2017)
You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You recently experienced domestic violence

Documentation REQUIRED to be submitted with application: None


You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You experienced the death of a close family member

Documentation REQUIRED to be submitted with application: Copy of death certificate, copy of death notice from newspaper, funeral service program, funeral expenses, coroner's report, military notification of death, or copy of other official notice of death. Must be within the last three years (2015 - 2017)
You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property

Documentation REQUIRED to be submitted with application: Copy of police or fire report, insurance claim, or other document from a government agency or news source about the disaster. Must be within the last three years (2015 - 2017)
You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You filed for bankruptcy

Documentation REQUIRED to be submitted with application: Copy of official bankruptcy filing documents. Must be within the last three years (2015 - 2017)


You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You had medical expenses you could not pay

Documentation REQUIRED to be submitted with application: Copies of medical bills. Must be within the last three years (2015 - 2017)

You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member

Documentation REQUIRED to be submitted with application: Copies of receipts for bills or services related to care like medical bills, home care services, or transportation receipts. Must be within the last three years (2015 - 2017)
You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You expect to claim a child as a tax dependent who has been denied coverage in Medicaid and the Children’s Health Insurance Program (CHIP), and another person is required by court order to give medical support to the child

Documentation REQUIRED to be submitted with application: Copy of court order that covers the time period for which you want the exemptions for the tax dependent AND copies of eligibility notices showing the dependent has been denied Medicaid and CHIP coverage. Must be within the last three years (2015 - 2017)
You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
As a result of a Health Insurance Marketplace appeals decision, you are eligible either for: 1) enrollment in a qualified health plan through the Marketplace, 2) lower costs on your monthly premiums, or 3) cost-sharing reductions for a time period when you were not enrolled in a Marketplace plan

Documentation REQUIRED to be submitted with application: Copy of Marketplace notice of appeals decision. The notice must show the names of everyone in your household who wants this exemption. Must be within the last three years (2015 - 2017)
You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
An adult in your tax household was determined ineligible for Medicaid because your state did NOT expand eligibility for Medicaid under the Affordable Care Act

For a list of states that have expanded Medicaid or are planning to expand Medicaid, click here

Documentation REQUIRED to be submitted with application: Copy of notice of denial of eligibility for Medicaid. The notice must be from a date during the time period for which you are requesting this exemption. Must be within the current year (2017)
You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"
You experienced a hardship that kept you from getting health insurance that is NOT listed above

Example: You were enrolled in a "limited-benefit" Medicaid or CHIP program that is NOT recognized as minimum essential health coverage such as a medically needy Medicaid (Share-of-Cost or Spend-Down Medicaid)

Documentation REQUIRED to be submitted with application: Submit documentation to show why you are requesting a hardship exemption. Must be within the last three years (2015 - 2017)
You may ONLY claim this exemption by filing an hardship application with the Marketplace and obtain an "Exemption Certificate Number (ECN)"

 

Click here to Return to Affordable Care Act Home Page