Understanding the Health Care Exemption Form

Applying for a Hardship Exemption

Hardship exemptions are granted in cases where personal or financial setbacks made it difficult or impossible to obtain health insurance coverage during the tax year. The Affordable Care Act officially recognizes 14 different categories of hardships, including [source: Healthcare.gov]:

  • Death or prolonged illness of a family member
  • Domestic violence
  • Substantial debt from unpaid medical expenses
  • Eviction, foreclosure or homelessness
  • Bankruptcy or shut-off notices from utilities
  • Fire, flood or other disaster

There is a single application form for all hardship exemptions and it's called the Application for Exemption from the Shared Responsibility Payment for Individuals Who Experience Hardships. Each category of hardship is assigned a number from 1 to 14. Most categories require additional documentation to verify the hardship. For example:

  • To claim a hardship exemption because of an eviction in the past six months, you need to include a copy of the eviction notice.
  • To claim a hardship exemption because of unpaid medical expenses over the past 24 months, the marketplace wants to see copies of the medical bills.
  • If you're claiming a hardship exemption because a family member died, you'll need to attach a copy of the death certificate or the obituary from the newspaper.

There is no additional documentation needed in cases of homelessness or domestic violence.

The exemption application itself is pretty straightforward. First, the application asks for information about one adult in the house who will act as the main contact. Then it asks basic information about other people in the household, including Social Security numbers and filing statuses for tax purposes.

Then the application gets to the information about the hardship itself. There's a small box to enter the category number of the hardship, followed by a paragraph-sized box in which to explain how the hardship prevented you from getting health coverage. You are further asked to enter the start and end dates of the hardship (If it's ongoing, there's a box for that, too). If you are applying for more than one hardship exemption, you make multiple copies of the application page.

If you need help completing the application, you can have an "authorized representative" — a friend or a professional health care counselor — complete and sign the application for you. All you have to do is sign and include the form marked "Appendix A: Assistance with completing this application" with the application.

Now let's look at the application forms for non-hardship exemptions for things like financial and religious reasons.