Get Coverage Fees-exemptions

Hardship exemptions, forms & how to apply

Hardships are financial situations and other circumstances that keep you from getting health insurance. If you qualify for a hardship exemption, you don’t have to pay a fee for the months you were uncovered.

To claim a hardship health coverage exemption, you must fill out an application, print it, and mail it to the Health Insurance Marketplace. If your exemption is approved, you claim it when you file your federal income tax return.

Need a hardship exemption form?

2016 hardship exemptions

Following are all health coverage exemptions based on hardships. The links below take you to a page with details about each exemption, forms, and instructions.

  1. You were homeless

  2. You were evicted or were facing eviction or foreclosure

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

  4. You experienced domestic violence

  5. You experienced the death of a family member

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

  7. You filed for bankruptcy

  8. You had medical expenses you couldn’t pay that resulted in substantial debt

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

  10. You claim a child as a tax dependent who’s been denied coverage for Medicaid and CHIP for 2016, and another person is required by court order to give medical support to the child. In this case you don’t have to pay the penalty for the child.

  11. 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 in 2016

  12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid in 2016 under the Affordable Care Act

  13. Your "grandfathered" individual insurance plan (a plan you’ve had since March 23, 2010 or before) was cancelled because it doesn’t meet the requirements of the Affordable Care Act and you believe other Marketplace plans are unaffordable

  14. You had another hardship. If you experienced another hardship obtaining health insurance, use this form to describe your hardship and apply for an exemption. use this form to describe your hardship and apply for an exemption.

Common questions

Hardship exemptions usually cover the month before the hardship, the months of the hardship, and the month after the hardship. But in some cases the Marketplace may provide the exemption for additional months, including up to a full calendar year.
  • For people ineligible for Medicaid only because a state hasn’t expanded Medicaid coverage, the hardship exemption will be granted for the whole calendar year.
  • For people eligible for Indian Health Services, the hardship exemption lasts as long as you remain eligible.
  • For people under 21 who are eligible for an exemption due to religious conscience, you’ll need to reapply if you remain a member when you turn 21.
There’s no exemption based only on employment status. But several exemptions apply to people with no or very little income.
  • If you’re granted a hardship exemption, the notice includes information on catastrophic health plans. With a hardship exemption, you can buy a catastrophic plan no matter how old you are or what your income is.
  • A catastrophic plan offers lower-priced coverage that mainly protects you from high medical costs if you get seriously hurt or injured.
    To buy catastrophic coverage with a hardship, you’ll provide your Exemption Certificate Number (ECN) to the insurance company selling the plan.
  • You don’t have to buy a Catastrophic plan if you get a hardship exemption. It’s just a lower-cost coverage option available to you.
  • To buy Catastrophic coverage with a hardship in the Marketplace, you’ll enter your Exemption Certificate Number (ECN) on your application. When you compare plans you’ll see available Catastrophic plans. If you buy a Catastrophic plan outside the Marketplace, provide your ECN to the insurance company selling the plan.

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