Obamacare Individual Insurance Exemptions

The IRS has just released Publication 5172 which details some of the Exemptions/Waivers for individuals to purchase health insurance this year. The exemptions mainly have to do with hardships or lack of income/affordability for insurance, but some could be interpreted pretty broadly.

Here is a short list from the IRS website:

Exemptions May only be granted by Marketplace May be granted by Marketplace or claimed on tax return May only be claimed on tax return
Coverage is considered unaffordable - The amount you would have paid for employer-sponsored coverage or a bronze level health plan (depending on your circumstances) is more than eight percent of your actual household income for the year as computed on your tax return. Also see the second hardship listed below, which provides a prospective exemption granted by the Marketplace if the amount you would have paid for coverage is more than eight percent of your projected household income for the year. Yes
Short coverage gap - You went without coverage for less than three consecutive months during the year. For more information, see question 22 of ourquestions and answers. Yes
Household income below the return filing threshold - Your household income is below the minimum threshold for filing a tax return. Learn more about household income. Yes
Certain noncitizens - You are neither a U.S. citizen, aU.S. national, nor an alien lawfully present in the U.S. Yes
Members of a health care sharing ministry - You are a member of a health care sharing ministry, which is an organization described in section 501(c)(3) whose members share a common set of ethical or religious beliefs and have shared medical expenses in accordance with those beliefs continuously since at least December 31, 1999. Yes  

 

 

 

 

Members of Federally-recognized Indian Tribes - You are a member of a federally-recognized Indian tribe. Yes
Incarceration - You are in a jail, prison, or similar penal institution or correctional facility after the disposition of charges. Yes
Members of certain religious sects - You are a member of a religious sect in existence since December 31, 1950, that is recognized by the Social Security Administration (SSA) as conscientiously opposed to accepting any insurance benefits, including Medicare and Social Security. Yes
Hardships:
  • Your gross income is below the filing threshold. To find out if you are required to file, use ourInteractive Tax Assistant.
Yes
  • Two or more family members’ aggregate cost of self-only employer-sponsored coverage exceeds 8 percent of household income, as does the cost of any available employer-sponsored coverage for the entire family.
Yes
  • You purchased insurance through the Marketplace during the initial enrollment period but have a coverage gap at the beginning of 2014. See thisHHS Question and Answer.
Yes
  • You are experiencing circumstances that prevent you from obtaining coverage under a qualified health plan. Learn more about the criteria for this exemption.
Yes
  • You do not have access to affordable coverage based on your projected household income.
Yes
  • You are ineligible for Medicaid solely because the State does not participate in the Medicaid expansion under the Affordable Care Act.
Yes
  • You are an American Indian, Alaska Native, or a spouse or descendant who is eligible for services through an Indian health care provider. Learn more.
Yes
  • You have been notified that your health insurance policy will not be renewed and you consider the other plans available unaffordable. See HHS guidance and HHS Questions and Answers for more information.
Yes

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From a tax/estate planning view, it would seem that the last “hardship” of cancelled insurance and then your own consideration that available plans are unaffordable would sidestep the whole law.

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