Individual Mandate Exemption Qualifications

Individual Mandate Exemption Qualifications


        The Individual Mandate Exemptions

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If you don’t have coverage, there are some situations in which you may be exempt from paying the penalty fee.

You may qualify for an exemption if the following applies:

     • You lack coverage for less than three months of the year.

     • The lowest-priced insurance available costs more than 8 percent
     (8.05 percent for 2015) 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 you are 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.

     • You are not lawfully present in the United States.

You may also qualify for a hardship exemption if one of the following circumstances applies to you, affecting your ability to purchase health coverage:

     • You were homeless.

     • You were evicted, or faced eviction or foreclosure, in the past six months.

     • You received a shut-off notice from a utility company.

     • You recently experienced domestic violence.

     • You recently experienced the death of a close family member.

     • You suffered a fire, flood or other natural or human-caused disaster
     that caused substantial damage to your property.

     • You filed for bankruptcy in the past six months.

     • You had medical expenses you couldn’t pay in the last 24 months.

     • You experienced unexpected increases in necessary expenses due to
     caring for an ill, disabled or aging family member.

     • You expect to claim a child as a tax dependent who has 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 to pay the penalty for
     the child.

     • 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.

     • You were determined ineligible for Medicaid because your state didn’t
     expand eligibility for Medicaid under the ACA.

     • Your individual insurance plan was cancelled, and you believe other
     Marketplace plans are unaffordable.

     • You experienced another similar hardship in obtaining health insurance.

One of the key components of the Affordable Care Act (ACA) is that everyone is required to obtain health coverage. If you don’t have coverage, you are not only responsible for paying all of your health care expenses out of pocket, but you will also be subject to a fee. However, in a few special situations, you may qualify for an exemption from the penalty.


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