Individuals who believe they may be eligible for an exemption should apply for the exemption from the Federal Health Insurance Marketplace, Healthcare.gov. These exemptions are not issued by Connect for Health Colorado. For more information on how to apply, visit the federal website on exemptions or call 1-800-318-2596. Eligible individuals will receive an Exemption Certificate Number from the federal government. Be sure to save this number for when you file your taxes. Individuals applying for an exemption based on coverage being unaffordable, membership in a health care sharing ministry, membership in a federally-recognized tribe or being incarcerated can claim these exemptions when they file their taxes and do not need to apply for an exemption beforehand.
Note: If you get an exemption because coverage is unaffordable based on your expected income, you may also qualify to purchase a Catastrophic plan through Connect for Health Colorado. This may be more affordable than your other options. However, the Premium Tax Credit cannot be applied to Catastrophic plans.
Starting in 2019, there is no requirement for individuals to have a Qualified Health Plan or pay a penalty. However, for 2018, the penalty remains the law. Under the Tax Cuts and Jobs Act, taxpayers must continue to report having minimum essential health insurance coverage, qualify for an exemption, or pay the individual shared responsibility payment for tax year 2018. The Internal Revenue Service (IRS) is responsible for enforcing this requirement. For individuals who fail to have insurance in 2018, the penalty will be the greater of $695 or 2.5% of your income. Certain exemptions from this general rule may apply. For more information about whether you might qualify for an exemption, please visit Healthcare.gov, or speak with your tax professional. Among other qualifying exemptions, listed below are examples of certain “hardship exemptions” for which you might qualify:
- You were homeless.
- You were evicted in the past 6 months or were facing eviction or foreclosure.
- You received a shut-off notice from a utility company.
- You recently experienced domestic violence.
- You recently experienced the death of a close family member.
- You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
- You filed for bankruptcy in the last 6 months.
- You had medical expenses you couldn’t pay in the last 24 months, that resulted in substantial debt.
- You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
- You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child.
- 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.
- You were determined ineligible for Medicaid because your state didn?t expand eligibility for Medicaid under the Affordable Care Act.
- Your individual market coverage was cancelled, and you consider the other plans are unaffordable.
“Minimum Essential Coverage” is a standard or type of coverage you need to meet the individual mandate requirement under the Affordable Care Act. Some examples of health insurance plans that qualify as Minimum Essential Coverage are:
- Any Connect for Health Colorado plan
- Medicare (certain Parts and conditions apply)
- Children’s Health Plan Plus (CHP+)
- TRICARE (for veterans and veteran families)
- Peace Corps
- Volunteer plans
Some examples of coverage that doesn’t qualify as Minimum Essential Coverage are:
- Coverage only for vision care or dental care
- Workers compensation
- Coverage only for a specific disease or condition
- Plans that offer only discounts on medical services
- Short-term, limited-duration insurance