This exemption will be filed for at tax time. There will be a list of regions with 1 or less insurer, so keep in that in mind.
To restate and to ensure clarity, this means those who don’t have coverage, and who live in a region where they have one or less insurers to chose from, will be able to tax an exemption on form 8965 at tax time to avoid owing the fee for not having health coverage this year.
This won’t matter starting 2019, as the mandate has been repealed starting next year.
With that covered, it is worth noting that no states have zero insurers, but enough have only one that this could benefit many (who didn’t get insurance or didn’t want it but got it to avoid the fee).
This was done as part of a CMS-based reform that makes slight changes to the ACA to put more power in the hands of states and to curb rules and regulations set forth by the ACA that individuals, insurers, states, and businesses have to follow. See the full set of rules: CMS issues final 2019 Payment Notice Rule to increase access to affordable health plans for Americans suffering from high Obamacare premiums. See the document on this hardship exemption only: Guidance on Hardship Exemptions from the Individual Shared Responsibility Provision for Persons Experiencing Limited Issuer Options or Other Circumstances.