A list of ObamaCare’s Exemptions, including Hardship Exemptions, you can apply for in order to qualify for Special Enrollment or be exempt from the fee can be found below.
This page just covers the basics, see our page on ObamaCare Exemptions for further details on exemptions and the fee.
What Are Exemptions?
Exemptions are qualifying life events that do one of three things:
- Exempt you from the requirement to have coverage (and thus the requirement to make the Individual Shared Responsibility Payment for not having coverage).
- Qualify you for a Special Enrollment Period to get Marketplace coverage.
- Qualify you for Catastrophic Coverage outside of the Marketplace.
NOTE: Almost everyone who got coverage qualifies for one of the coverage gap exemptions.
What Are the Exemption Types?
There are two types of exemptions regular exemptions and hardship exemptions.
Hardship Exemptions and Catastrophic Coverage
If you are over 30, only a Hardship Exemption will qualify you to shop for Catastrophic coverage and not paying the fee.
Other exemptions will simply exempt you from paying the fee, but won’t qualify you to purchase a low premium Catastrophic health plan.
How Do I Claim an Exemption?
Some exemptions are applied for at the Marketplace, others are claimed on your tax return, some require both.
When you file your taxes, you may need to use Form 8965 to claim exemptions. See our ObamaCare Facts simplified instructions for Form 8965, Health Coverage Exemptions.
Do Exemptions Require Proof?
Some, but not all exemptions, require proof. (list of proofs required for exemptions is found below)
How Do I Apply for an Exemption?
Apply for exemptions at HealthCare.Gov. You’ll need to fill out an application and send proof if required. It takes time to process your application, so don’t wait until the last minute.
Electronic Confirmation Number
Marketplace exemptions, when confirmed, result in the Marketplace issuing you an Electronic Confirmation Number (ECN) which you’ll use to claim the exemption on your taxes.
How Long Do Health Insurance Exemptions Last?
The following exemptions are regular exemptions that exempt you from the fee. Short coverage gaps, and some hardship exemptions, only last a limited amount of time (typically 60 days.)
Full List of Regular Exemptions
Below is a full list of exemptions. Keep in mind there are about 20 hardship exemptions below this list.
TIP: Specifics are subject to change each year, for example, the 9.5% and 8% numbers are adjusted slightly to 8.13% and 9.69% for 2016. Most of the general information applies, but make sure to check the official 8965 form instructions.
• Unaffordable Coverage Options- People who would have to pay more than 8% of their household income (MAGI) for the lowest priced Marketplace Health Insurance after subsidies qualify for this exemption. If employer insurance is unaffordable, costing more than 9.5% after employer contributions for self-only coverage, you will likely qualify for this exemption. You also qualify if average costs of premiums on an employer plan is more than 8% MAGI. You must apply for this exemption. Remember that your MAGI is not your taxable income; it includes the amounts you invested into non-taxable savings accounts, income from Social Security, and educational expenses.
NOTE: If your employer’s coverage is considered affordable (less than 9.5% of your household income), you will not qualify for an exemption from the fee yourself, but your uninsured dependents may still qualify. The fee is 1/12 the fee per month for each family member without coverage.
• Low Income/No Filing Requirement- People with incomes below the IRS threshold required for filing taxes (in 2013, $10,000 for a single person and $20,000 for a married couple) are exempt. This exemption is automatic.
• Hardship Exemption- The Health Insurance Marketplace, also known as the Affordable Insurance Exchange, has certified that you have suffered a hardship that makes you unable to obtain coverage either for financial or other reasons. There are many situations which will qualify you for a hardship exemption, so please see below for the full list. Essentially, if you wanted to buy health insurance, but were unable because of a hardship, you qualify. All you need to do is apply and provide documentation of your hardship.
NOTE: If your plan was canceled or became unaffordable in 2014 because of the Affordable Care Act, you qualify for a hardship exemption in 2014 only and were not required to obtain coverage for 2014.
• Short Coverage Gap Exemption- If you go without coverage for less than three consecutive months during the year you will not be responsible for the fee for those months. This allows people who don’t have a plan to sign up by the end of open enrollment (typically Feb 15th each year) and still be exempt from the fee. It also allows folks who have had coverage throughout the year downtime between insurance options for when they may experience a life change like moving or switching jobs. The coverage gap doesn’t apply if you don’t get covered; if you have more than one gap, it only applies to the first gap of fewer than three months. It can be paired with other exemptions.
NOTE: There was another coverage gap exemption for coverage purchased at any time during open enrollment 2014. This exemption applied to those who purchased marketplace insurance between March 15th and March 31st, 2014 (that coverage didn’t start until May 1st, 2014).
• Religious Conscience- People can qualify for religious exemptions. The Social Security Administration administers the process for recognizing these sects according to the criteria in the law.
• Health Care Sharing Ministry- If you are a member of a recognized health care sharing ministry you qualify for an exemption.
• Incarceration- People who are incarcerated are exempt.
• Indian tribes- Members of a federally recognized Indian tribe are exempt.
Full List of Hardship Exemptions
ObamaCare’s hardship exemptions apply to those who have had certain life circumstances that qualify as “hardships.” There are many things that will qualify you for a hardship, but in simple terms: If you wanted to buy health insurance and you were unable to because of a life circumstance or situation outside your control then you most likely qualify for a hardship exemption.
If any of the following circumstances apply to you, you may qualify for a hardship exemption from paying the fee, and qualify for a catastrophic plan, or qualify for a special enrollment period. Not all exemptions last for a full calendar year. You’ll need to submit documentation to be granted an exemption in most cases.
Information below obtained from HealthCare.Gov
ObamaCare Hardship Categories and Documentation
You may qualify for a hardship exemption if you experienced one of the following:
|Hardship number||Category||Submit this documentation with your application|
|1.||You were homeless.||None|
|2.||You were evicted in the past 6 months or were facing eviction or foreclosure.||Copy of eviction or foreclosure notice|
|3.||You received a shut-off notice from a utility company.||Copy of shut-off notice from a utility company|
|4.||You recently experienced domestic violence.||None|
|5.||You recently experienced the death of a close family member.||Copy of death certificate, copy of death notice from newspaper, or copy of other official notice of death|
|6.||You experienced a fire, flood, or other natural human-caused disaster that caused substantial damage to your property.||Copy of police or fire report, insurance claim, or another document from government agency, private entity, or news source documenting event|
|7.||You filed for bankruptcy in the last 6 months||Copy of bankruptcy filing|
|8.||You had medical expenses you couldn’t pay in the last 24 months.||Copies of medical bills|
|9.||You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.||Copies of receipts related to care|
|10.||You expect to claim a child as a tax dependent who’s 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.||Copy of medical support order AND copies of eligibility notices for Medicaid and CHIP showing that the child has been denied coverage|
|11.||As a result of an eligibility appeals decision, you’re eligible either for 1) enrollment in a qualified health plan (QHP) through the Marketplace, 2) lower costs on your monthly premiums, or 3) cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.||Copy of notice of appeals decision|
|12.||You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.||Copy of notice of denial of eligibility for Medicaid|
|13.||You received a notice saying that your current health insurance plan is being canceled, and you consider the other plans available unaffordable.||Copy of notice of cancellation|
|14.||You experienced another hardship in obtaining health insurance.||Please submit documentation if possible|
|NEED HELP WITH YOUR APPLICATION? Visit HealthCare.gov or them at 1-800-318-2596. Para obtener una copia de este formulario en Español, llame 1-800-318-2596. If you need help in a language other than English, call 1-800-318-2596 and tell the customer service representative the language you need. We’ll get you help at no cost to you. TTY users should call 1-855-889-4325.|
Other Hardship Exemptions
Beyond the hardship exemptions above there are three other exemptions (2 of which were unique to 2014).
- Two or more family members’ aggregate cost of self-only employer-sponsored coverage is more than 8% of household income, as is the cost of any available employer-sponsored coverage for the entire family.
- You purchased insurance through the Marketplace during the initial enrollment period but have a coverage gap at the beginning of 2014.
- You applied for CHIP coverage during the initial open enrollment period and were found eligible for CHIP based on that application but have a coverage gap at the beginning of 2014.
- You were engaged in service in AmeriCorps State and National, VISTA, or NCCC programs and were covered by short-term duration coverage or self-funded coverage provided by these programs.
- You were eligible but did not purchase, coverage under an employer plan with a plan year that started in 2013 and ended in 2014. (Available only in 2014.)
- You were enrolled in certain types of Medicaid and TRICARE programs that are not minimum essential coverage. (Available only in 2014.)
- You had some specific types of limited benefit coverage. These are mostly limited benefit Medicaid or TRICARE plans. See IRS Notice 2014-10. Further details can be found on the 8965 Form. (Available only in 2014.)
The Medicaid Exemption and Special Enrollment Period
Applying for Medicaid or CHIP and being rejected can grant you not only an exemption but also a special enrollment period. You’ll need to have your rejection letter as proof to qualify for either.
Exemptions for Citizens Living Abroad
You are exempt if you were:
- A U.S. citizen or resident who spent at least 330 full days outside of the U.S. during a 12– month period; A U.S. citizen who was a bona fide resident of a foreign country or U.S. territory;
- A resident alien who was a citizen of a foreign country with which the U.S. has an income tax treaty with a nondiscrimination clause, and you were a bona fide resident of a foreign country for the tax year;
- or Not a U.S. citizen, not a U.S. national, and not an individual lawfully present in the U.S. For more information about who is treated as lawfully present for purposes of this coverage exemption, visit healthcare.gov.
NOTE: The 12 month period can be any 12 month period. You’ll be exempt for any months of that 12 month period that fall within the tax year. Learn more about the 330-day rule here.
Remember you’ll need to apply for exemptions, and file the exemptions form to officially claim your exemption. Don’t wait until the last minute.