QUESTION

On what grounds can I apply for a hardship exemption to the individual mandate for 2018?

Individuals with no coverage | Individual Responsibility Requirement (Individual Mandate)
ANSWER

People may apply for a hardship exemption from the marketplace if they have experienced difficult financial or domestic circumstances that prevent them from obtaining coverage — such as homelessness, death of a close family member, domestic violence, bankruptcy, substantial recent medical debt, or disasters that substantially damage a person’s property. People may also apply for a hardship exemption if obtaining coverage would be so burdensome as to cause the applicant to experience other serious situations like the deprivation of food, shelter, or other necessities. Other circumstances that will qualify an individual for a hardship exemption include living in an area with only one marketplace insurer, or an area where the only available marketplace plan(s) cover(s) abortion. Consult your marketplace for more information about hardship exemptions.

For the 2018 plan year, the federal government will allow individuals to claim a hardship exemption by directly filing with the IRS without submitting any documentation or providing written explanation (however, consumers are asked to keep documentation showing qualification(s) for the hardship exemption with their tax records). (26 U.S.C. § 5000A (e)(5); 45 C.F.R. § 155.605; HealthCare.gov, Hardship exemptions, forms & how to apply; CMS, Guidance on Hardship Exemptions from the Individual Shared Responsibility Provision for Persons Experiencing Limited Issuer Options or Other Circumstances, April 9, 2018; CMS, Guidance on Claiming a Hardship Exemption through the Internal Revenue Service (IRS), September 12, 2018).

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