Check insurance exemptions under ACA

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By Meg Chevalier, a senior tax specialist in the Providence office of the Internal Revenue Service

By Meg Chevalier, a senior tax specialist in the Providence office of the Internal Revenue Service

The individual shared responsibility provision of the Affordable Care Act requires you and each member of your family to have qualifying health insurance coverage, also called minimum essential coverage; qualify for an exemption; or make an individual shared responsibility payment when you file your federal income tax return.

Many people already have minimum essential coverage and don’t need to do anything more than maintain that coverage. You may be exempt from the requirement to maintain minimum essential coverage and may not have to make a shared responsibility payment when you file your federal income tax return if you meet certain criteria.

You may be exempt if you:

Have no affordable coverage options because the minimum amount you must pay for the annual premiums is more than 8 percent of your household income.

• Are uninsured for less than three consecutive months of the year.

• Qualify for an exemption for one of several other reasons, including having a hardship that prevents you from obtaining coverage.

• Belong to a group explicitly exempt from the requirement, including certain religious sects, a federally recognized Indian tribe or a health care sharing ministry.

Whether you get an exemption from the federal Health Insurance Marketplace or the Internal Revenue Service (IRS) depends on the type of exemption for which you are eligible:

• The religious conscience exemption and most hardship exemptions are available only by going to the Health Insurance Marketplace and applying for an exemption certificate.

• Several exemptions may be claimed only as part of filing a federal income tax return. Those include exemptions for lack of affordable coverage, a short coverage gap, certain hardships, household income below the filing threshold and individuals who are not lawfully present in the United States.

• Certain exemptions are available by going to the marketplace and applying for an exemption certificate, or they may be claimed as part of filing a federal income tax return. Those include exemptions for members of federally recognized Indian tribes, members of health care sharing ministries and individuals who are incarcerated.

If you or any of your family members don’t maintain health insurance coverage and don’t qualify for an exemption, you are required to make an individual shared responsibility payment when you file your federal tax return. The payment will be based on the number of months that you do not have coverage or an exemption.

Additional information about exemptions is available on the Individual Shared Responsibility Provision web page onIRS.gov/aca. It includes Publication 5156, Facts about the Individual Shared Responsibility Payment, and Questions and AnswersHealthcare.gov has more information on hardship exemptions.

By Meg Chevalier, a senior tax specialist in the Providence office of the Internal Revenue Service. To contact or ask her a question, e-mail miguelina.y.chevalier@irs.gov.

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