Who Qualifies for a Penalty Exemption Under the Affordable Care Act?

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Are you unsure if you need to sign up for health insurance? Don’t worry, TurboTax has you covered and can help you understand who is exempt from having insurance under the Affordable Care Act.

The Affordable Care Act requires that all Americans have health insurance starting in 2014. Those who choose to not have insurance will have to pay a tax penalty unless they qualify for an exemption.

The tax penalty can also be called an “individual responsibility payment.”

The tax penalty is based on family size and income. For 2014, the fee is $95 per adult or one percent of your total yearly income depending on your income and is paid when you file your 2014 federal tax return (the one you file in 2015).

The annual fee will increase each year, and the IRS has a free online tool to determine if you’re eligible for an exemption. If you go without coverage for only part of the year, you’ll pay a partial fee; if you’re uninsured for less than three consecutive months, you won’t have to pay a fee at all.

But for some Americans who do not already have insurance through their employer, their parents, Medicaid, Medicare, TRICARE, the Veterans health care program, or individual insurance – you may be exempt.

The Affordable Care Act exemptions cover a variety of people, like followers of particular religious groups, members of Native American tribes, and people who do not meet the minimum income requirement, for which health care coverage would be considered unaffordable.

Most people must have health care coverage or pay the tax penalty, but here’s a list of specific cases where you may be able to get an exemption.

Exemptions include:

  • You’re uninsured for less than 3 consecutive months of the year
  • Your lowest-priced coverage option is more than 8% of your household income
  • You don’t have to file a tax return because your income is under the IRS filing requirement ($10,000 if single, 20,000 married filing jointly)
  • You’re a member of a federally recognized tribe or 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 administering of charges against you
  • You’re not lawfully present in the United States,
  • You may qualify for the Cancellation Hardship Exemption if you received a cancellation notice due to your health plan not meeting minimum requirements.
  • You also may qualify for a hardship exemption if your circumstances affected your ability to purchase health coverage

A complete list of exemptions is available at Healthcare.gov.

How to apply for exemptions

Do you qualify for one of these conditions? If so, then what’s next?

If you’ve been uninsured for less than three consecutive months of the year, or you aren’t lawfully present in the U.S., you don’t need to apply for an exemption. This will be handled when you file your 2014 taxes next year.

Also, if you don’t have to file a tax return because your income is too low, you don’t need to apply.

You can claim certain other exemptions on your 2014 tax return when you file in 2015, such as exemptions based on coverage being unaffordable or being a member of a federally recognized tribe or ministry.

For all other exemptions, you’ll have to submit an application to the Health Insurance Marketplace along with required documentation in certain cases. Different exemptions require different forms, so be sure to apply with the correct form. You can find and print all of the forms here.

64 responses to “Who Qualifies for a Penalty Exemption Under the Affordable Care Act?”

  1. I work at a clinic and I work in the lab. The clinic has changed lab companies 2 times not allowing me the chance to get insurance and when I finally did, it doesn’t start until Jan 1. This stretch was from Sept to December. Why am I required to pay the penalty it wasn’t my fault…

  2. Hi I worked thru a temporary agency with my current employer until they hired me on March of 2015, but they never offered me their health insurance because they said the enrollment was already closed (they only do a one time enrollment in November of every year) so I was not able to get in their health insurance plan, does that mean I will have to pay the penalty fee for having no insurance for the whole year 2015 or is any way I can get an exemption when filing my income taxes

  3. Hello, I’m 21 and depedent on my taxes. I had health insurance but it was removed once I had a job over the summer. By the time my job offered me health insurance I had to leave to school. I made around 5500. How much of a penalty would I have to pay?

  4. My wife is a stay-at-home mother without medical coverage. We’ve been paying the Obamacare penalty because it’s automatically taken off our electronically-filed return.

    Because we file joint, does that negate her eligibility for an exemption for insufficient income? She has $0.00 income individually, but does the application of the penalty for a person filing joint get based on the combined income of the married couple?

  5. Hello! I was under 26 and on my parents’ insurance until May and then got insurance for June-December through the marketplace. How can I show this legitimate reason on my turbotax form? Also, is there a place for me to upload my 1095a’s that I received from healthcare.gov? Thank you!

  6. Hello, I had a job at one company; that i had insurance thru,changed jobs and got hurt. I’m on workers comp. Insurance. My injury will take about 1 year to recoup from surgery,and apply for insurance thru company. What are my opitons? Thank you j.miller.

  7. I am a single mother with two sons, 22 and 24 and a 17 year old daughter. I cannot afford to cover my kids through my work. It would cost me nearly 500 a month. Both sons work and are in college but don’t have access to other health insurance as they don’t work enough to qualify for it or to pay for it. What are our options?

  8. Will Turbo Tax guide and handle my situation? I am a resident of Japan and subscribe to the national insurance. I don’t see this situation listed for an exemption.

  9. If you are self employed and only made $16,000 for the year do you still need to file taxes (because of SS)? If you do have to file because of SS would the exemption still apply since it is under the amount required?

  10. Is Vision and/or Dental cost considered part of the Affordable Care Act requirements for health insurance when calculating the 8% of your household income?

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