ObamaCare Mandate: Exemption and Tax Penalty

The ObamaCare Mandate and How You Can Qualify for an Exemption from the Tax “Penalty”

ObamaCare Mandate: Those who choose not to purchase insurance will have to pay a tax “penalty” unless they qualify for an exemption. Exemptions from ObamaCare’s tax “penalty” mandate are available to a number of Americans. We will cover all of the ObamaCare exemptions below, but first let’s take a look at how to avoid the fee and what happens if you don’t get covered.

FACT: The fee is sometimes called a penalty, fine, or Individual Shared Responsibly Payment. It is part of the Individual Shared Responsibility Provision, which is often called the Individual Mandate. On this page we will discuss exemptions from the mandate’s requirement to obtain coverage or pay a fee.

Avoiding the ObamaCare Fee

The Individual Mandate (AKA the Individual Shared Responsibility Provision ) is the part of the Affordable Care Act that says you must obtain and maintain minimum essential coverage throughout the year, get an exemption, or pay a fee on your Federal Income Taxes for each month you, or your dependent, go without coverage.

To avoid the penalty you must obtain minimum essential coverage and maintain it throughout the year, or get an exemption. Make sure you and your dependents are covered during your health plan type’s open enrollment period. Most Health Plans sold outside of open enrollment do not count as minimum essential coverage (the type of coverage you need to avoid the per month fee). The only way around this qualifying for special enrollment, or another insurance type like Medicaid or CHIP.

How to Qualify For An Exemption

The easiest way to qualify for an exemption is to go to HealthCare.Gov and sign up for a marketplace account. When you sign up, you automatically find out if you qualify for some exemptions, and might even find you qualify for lower costs on coverage. You may even qualify to shop for a catastrophic plan with lower premiums, if you obtain a Hardship Exemption.

Other exemptions are simply claimed on your 1040 Federal income tax return using the ObamaCare exemptions form 8965. Although you don’t have to apply for some exemptions, it’s smart to check with the marketplace as many exemptions also trigger special enrollment periods allowing you more coverage options.

If you plan on applying for an exemption, don’t leave it to the last minute. In many cases, you’ll have to fill out a form and wait for confirmation before you can report the exemption. In addition, many exemptions require certain documentation to verify you qualify. Obtaining that documentation also takes time. Waiting can mean a delay of your Federal Tax Refund.

• Apply for exemptions at HealthCare.Gov.
• There are about 20 different exemptions, including hardship exemptions. Some exemptions require documentation, some don’t.
• Many exemptions require an Electronic Confirmation Number (ECN). (If you don’t have yours in time, just report “PENDING” instead of the exemption code.)
• Some exemptions only last 3 months, others last a calendar year.
• Some exemptions will qualify you for a catastrophic health plan and/or a special enrollment period, some will just help you avoid the fee.
• Some exemptions don’t require to apply or qualify for before hand and can simply be claimed on your 1040.

There are many exemptions from the fee and according to the CBO as many as 26 million Americans will qualify for one. Look below to see if your qualify for an exemption from the tax penalty on your yearly Federal Income Taxes.

FACT: 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.

Reporting Exemptions to the IRS

To report an exemption to the IRS you’ll use Form 8965, Health Coverage Exemptions(see example from Exemption instructions below). Some exemptions require you to report Electronic Confirmation numbers sent by the Marketplace upon approval of your exemption application. You’ll attach that form to your 1040 when you file your taxes. Learn more about filing taxes for ObamaCare.

How Much is the ObamaCare Fee?

The fee for not having insurance increases each year. See below for 2015 and 2014 fee.

In 2015, the Individual Shared Responsibility fee for not having insurance is $325 per adult and $162.50 per child (up to $975 for a family), or 2% of your taxable income, whichever is greater. The monthly fee is 1/12 of the total fee excluding coverage gap exemption. See Individual mandate for more details on the fee.

For the 2014 tax season, the Individual Shared Responsibility fee for not having insurance is $95 per adult and $47.50 per child (up to $285 for a family), or 1% of your income, whichever is greater. The monthly fee is 1/12 of the total fee excluding coverage gap exemptions. See Individual mandate for more details on the fee.

Find out how the fee works moving forward.

What Happens if I’m Not Exempt From ObamaCare and Don’t Pay the Fee

If you decide not to get coverage, and don’t qualify for an exemption, then you’ll have to make an Individual Shared Responsibility payment on your income tax return for each month you went without minimum essential coverage.

Can I Go to Jail for Not Paying the Fee?

The IRS cannot enforce the Individual Shared Responsibility Provision with jail time, liens, or any other of typical methods of collection. The only way for the IRS to collect the fee for not having health insurance, if you choose not to pay it, is for them to withhold the money you would get back (Federal Income Tax Refund) from the IRS after you file your income tax return.

How Do I File my Taxes for the Fee?

You’ll get a 1095-A, 1095-B, or 1095-C form from your insurer about what months you had coverage, you’ll use this to file your taxes. If you had an exemption for any months you may need a ECN number provided by the Health Insurance Marketplace. Find out details on how you file taxes for ObamaCare see our pages on filing taxes under the Affordable Care Act.

Full List of ObamaCare Exemptions

The mandate’s exemptions cover a variety of people including: members of certain religious groups and Native American tribes, undocumented immigrants (who are not eligible for health insurance subsidies under the law), incarcerated individuals, people whose incomes are so low they don’t have to file taxes (in 2014, it’s $10,150 for an individual or $20,300 for a married couple), people for whom health insurance is considered unaffordable (where insurance premiums after employer contributions or federal subsidies exceed limits of family income), and those going without insurance for less than three months in a row.

NOTE: Some exemptions exempt you for up to three months, and others exempt you for the calendar year. You won’t owe the fee for months you have an exemption for, however the goal isn’t to simply go without coverage or the fee. Some exemptions, mainly hardship exemptions, will not only exempt you for the fee, but qualify you forspecial enrollment allowing you to get covered outside of open enrollment as well. Make sure to apply for exemptions at HealthCare.Gov, as many exemptions require an Electronic Confirmation Number (ECN).

If you belong to any of the groups listed below you are exempt from ObamaCare’s mandate to “obtain minimum essential coverage” (i.e. buy insurance):

• 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. or if employer insurance is unaffordable, costing more than 9.5% MAGI after employer contributions for employee-only coverage, you will likely quality for this exemption (an aggregate cost of 8% for households qualifies for a Hardship Exemption). 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 employers 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 still may 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 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 less than three months. It can be paired with other exemptions.

NOTE: There was another coverage gap exemption that applied to those who purchase marketplace insurance between March 15th and April 15th, 2014 (that coverage didn’t start until May 1st, 2014). This allowed for an extra full month without coverage or the fee in 2014.

NOTE: You only need an exemption for “full months” you go without coverage. Coverage for even one day in a month counts as being covered.

• 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. Find out more about how Health Care Sharing Ministry exemptions work.

• Not lawfully present- If you are an undocumented immigrant; you are not legally a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S.

• Incarceration- People who are incarcerated are exempt.

• Indian tribes- Members of a federally recognized Indian tribe are exempt.

For those who can afford it and choose not to purchase health insurance the tax will be unavoidable. The money collected from these taxes goes towards funding ObamaCare and subsidizing hospitals who will have to cover unpaid emergency room visits. The money is also a down payment on your almost inevitable use of the health care system.

NOTE: ObamaCareFacts.com is a free informational website, nothing on our site should be taken as legal advice. Check out the official IRS website on exemptions and the Individual mandate for additional details.

ObamaCare 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 financial situation, than 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 fee, and/or qualify for a catastrophic plan, and/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

Other Hardship Exemptions

Beyond the hardship exemptions above there are three other exemptions (2 of which are 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.)

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.

Applying for Exemptions

You can learn about applying for exemptions here. In some cases, you’ll need to actually fill out a form and send it to the marketplace before you officially qualify for the exemption. Don’t leave this until the last minute.

Applying for a Hardship Exemption

To apply for a hardship exemption you can fill out the exemption form: Individuals who experience hardships (PDF). See instructions to help you fill out an exemption application (PDF).

For hardship exemptions, you should apply early, you need to get approved first and then wait for confirmation to be mailed to you. You’ll get an unique exemption certificate number (ECN) which can be used to qualify to shop for catastrophic coverage or used to confirm exemption when filing your taxes.

Learn more about hardship exemptions for Healthcare.Gov.

NOTE: If you qualify for a hardship exemption, you’ll also qualify for a catastrophic plan. Catastrophic plans are high deductible plans with low premiums. Since all plans coveressential benefits, it’s a great alternative to going without coverage. Even if you have an exemption.

How Long Do ObamaCare’s Exemptions and Hardship Exemptions Last?

Most hardship exemptions start the month before the hardship, the month of, and the month after. Some hardship exemptions and other non-hardship exemptions last the a full calendar year (typically, December 31st).

This means that while some exemptions will help you avoid a few months of the per-month fee, most are meant to qualify you for special enrollment rather than to simply exempt you from the fee.

• Affordability hardship exemptions are granted for the remaining months of the calendar year.
• Hardship exemptions due to being ineligible for Medicaid, because your state hasn’t expanded Medicaid, are granted for the remaining months of the calendar year.
• For people eligible for Indian Health Services, the hardship exemption will be granted on a continuing basis. It may be kept for future years without having to submit another application. This is true as long as there are no changes to your membership in a tribe or eligibility for services from an Indian health care provider.

Proof of ObamaCare Exemption

Most exemptions will require documentation, as listed above. If you cannot provide documentation, you may still qualify for certain exemptions, like for being homeless. That safest way to avoid the fee is to simply obtain health insurance. Some exemption will buy you more time to sign up and these tend to be the ones with more flexible requirements of proof. Other exemptions simply allow you to not pay the tax and these will tend to require proof.

What Types of Insurance Will Help Me Avoid the Fee?

To avoid the fee you’ll need to obtain minimum essential coverage. Most private health insurance options, Medicare, Medicaid, CHIP, TRICARE and all insurance sold on the marketplace will count as minimum essential coverage. In addition, people under 30 and those with hardship exemptions qualify purchase a Catastrophic plan which is also minimum essential coverage.

Most insurance types offered between each open enrollment will be short term health insurance, fixed benefit plans and supplemental insurance will not help you avoid the fee on their own, but they will help you be covered health-wise. Also, having one of these types of insurance doesn’t prevent you from qualifying for an exemption or hardship exemption to avoid the fee.

Not sure if your plan will help you avoid the fee? Simply ask your insurer, “is your plan ACA compliant” or “does it counts as minimum essential coverage?” Most major medical types count.

Important Exemptions to Understand

Two of the more important exemptions discussed above is the “Short Coverage Gap Exemption” and the “Hardship Exemptions” for things like a plan that canceled or your state did not expand medicaid. Let’s look at these in more detail:

Short Coverage Gap Exemption and Open Enrollment Exemption

The Short Coverage Gap Exemption allow you less than three full consecutive months without coverage.

That being said, in 2014, Americans had until March 31st, 2014 to enroll in a marketplace plan and still avoid the fee. So if you enrolled on March 31st and had coverage that starts on May 1st, 2014, you still avoid paying the Individual Shared Responsibility payment. As a rule of thumb, if you sign up during open enrollment, you avoid the fee. The exemption for singing up during open enrollment is claimed on the exemptions form.

If you (and your dependents) get covered during open enrollment, and maintain coverage all year, you won’t owe the fee. This is true even when open enrollment is officially extended, like it was in 2014.

NOTE: The gap is less than three months, not exactly three months. You’ll need at least one day of coverage in the third month.

ObamaCare Hardship Exemption Extension for Canceled Plans

On December 20th 2013 Health and Human Services (HHS) announced that the “hardship exemption” will exempt anyone who had their plan canceled due to the Affordable Care Act. These Americans will still be able to buy insurance and use subsidies, but they will not be responsible for the fee for going without coverage in 2014. Since they will now qualify for a hardship exemption they will also be eligible to buy a catastrophic plan outside the marketplace. A Catastrophic plan provides minimum essential benefits with high out-of-pocket costs, but very low premiums. We at ObamaCareFacts.com suggest, as always, that you buy the plan that is right for you and your family. Many times that plan is a silver level or higher that comes with reasonable deductibles, affordable out-of-pocket costs, and a solid insurer network.

UPDATE Canceled Plan Hardship Exemption: If you had your plan canceled due to the Affordable Care Act (your insurance company would have notified you of this) you are exempt from the mandate to buy insurance in 2014 and 2015. Also if your state and insurance company allow you, you can renew a canceled plan all the way up until October 2016. Even if you have an exemption due to a cancelled plan, you can still use the marketplace to get coverage. You will qualify to shop for a low premium, high out-of-pocket catastrophic plan outside the Health Insurance Marketplace.

ObamaCare Hardship Exemption Extension for People Living in States where Medicaid was not Expanded.

If you live in a state that did not expand Medicaid, you qualify for this hardship exemption. This one is a bit tricky though. You must apply for Medicaid in your state and be denied. Your “denial of eligibility” letter is the documentation you must send with your hardship exemption application. Essentially, if your state is refusing to accept tax money available them if they did expand Medicaid, than you are not required to pay that tax. The reason this is a hardship exemption from insurance based this idea: you would have had health insurance free of charge if your state had expanded. In states that expanded Medicaid, people who make less than 138% the Federal Poverty Level will qualify for Medicaid Coverage..

How the ObamaCare Mandate Works

Americans who can afford to purchase insurance, but chose not to, will have to pay an income tax “penalty”. This is officially a tax, but is also referred to as a “fee”, “penalty”, or “mandate”. The way the ObamaCare mandate works is that any non-exempt American without minimum essential coverage will owe a per-month fee. The fee is $325 per adult and $162.50 per child (up to $975 for a family) or 2% of your taxable income a year. The monthly fee is 1/12 of the total annual fee (example: $325/12= $27.08 per month). The total penalty amount cannot exceed the national average of the annual premiums of a “bronze level” health insurance plan on ObamaCare exchanges.

The fee is a per month fee for every month you go without insurance. You have a “Short Coverage Gap” exemption, meaning, you can go without minimum essential coverage for less than 3 months in a year without paying the fee.

The actual rules are a little more complicated depending on a number of factors including age of dependents and income. We suggested learning more about the specifics of how the Individual Mandate works if you plan to go without health insurance.

When Does the New ObamaCare Tax “Penalty” Come into Effect?

The fee for not complying with the ObamaCare Mandate will be paid on your 2014 Federal Tax Returns. The Health Insurance Marketplace sells plans that will help you avoid the fee and may offer you lower costs on coverage, so we suggest shopping there. Getting covered during the annual open enrollment period will ensure that you avoid paying the tax. Remember each insurance type has their own open enrollment period. Make sure you understand the health insurance marketplace deadlines to ensure you get a plan during open enrollment unless you qualify for an exemption from ObamaCare’s tax penalty.