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New York State of Health | Exemptions

Do I need to have health coverage?

Starting in 2014, most people must have health coverage or pay a penalty on their federal tax return called a “shared responsibility payment.” To avoid this penalty, you must have insurance that qualifies as minimum essential coverage. You don’t have to pay a penalty if you’re enrolled in any of the following types of health coverage:

  • health insurance purchased through any state health or minimum essential coverage purchased directly from a health insurance company
  • health insurance received from a plan for work, collect or for retirees
  • medicare
  • medicaid
  • child health plus
  • medical assistance for refugees
  • tricare
  • Veterans Health Care Programs (including the Veterans Health Care Program, VA (Champva) Civilian Health and Medical Program, and the Spina Bifida Health Care Benefits Program)
  • Peace Corps volunteer plans
  • self-funded health coverage offered to students by colleges for plan or policy years that began on or before December. 31, 2014

other plans may also qualify. Check with your insurance provider to see if your plan qualifies.

Reading: What is the fee for not having health insurance 2015

If you don’t have health insurance that is considered minimum essential coverage, you can get help paying for health coverage through any health state. check the ny state health tax credit and premium estimator to see if you qualify.

how much is the penalty?

There are two ways to calculate the penalty. if you have a sanction, you will pay the most expensive fine. the sanction for 2014 is:

  • 1% of your annual household income above the tax filing threshold for your filing status, or
  • $95 per person per year ($47.50 per child under 18 years). the maximum fine per family using this method is $285.

You will pay no more than the national average annual premium for a bronze plan purchased through the marketplace in 2014.

The penalty increases each year. in 2015, it will be 2% of annual household income or $325 per adult ($162.50 per child under 18). in 2016 and later years, it will be 2.5% of annual household income or $695 per adult ($347.50 per child under 18). the penalty is adjusted for inflation after 2016.

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If you don’t have insurance for part of the year, you’ll pay 1/12 of the annual penalty for each month you don’t have insurance. Generally, you do not have to pay the penalty if you are uninsured for less than 3 months. Click here for more information about penalties from the Internal Revenue Service (IRS) website.

who doesn’t have to pay the fine?

There are reasons why people may not have to pay a penalty for not having health insurance. People who may be exempt from the requirement to have health insurance or pay a penalty include:

  • people who cannot afford health insurance because insurance offered through a job or the marketplace is not affordable, as explained in the next section.
  • people who experienced hardship that prevented them from obtaining health coverage, including but not limited to: experiencing homelessness or domestic violence, facing eviction, or experiencing a fire, flood, or other disaster that caused substantial damage to their property. a complete list of hardships that may qualify is on the hardship waiver form.
  • people whose income is so low that purchasing health insurance during the tax year was unaffordable.
  • members of a religious sect with religious objections to health insurance.
  • members of a health care sharing ministry.
  • members of a federally recognized Indian tribe or eligible for services through an Indian health provider.
  • individuals who are incarcerated.
  • individuals who are not required to file a federal income tax return because their income is too low. click here for information on filing limits.
  • individuals not lawfully present in the united states. For information on who is considered lawfully present in the United States, click here.
  • people who do not have health insurance coverage for less than 3 months during the year.
  • people who have coverage through a Marketplace or non-Marketplace health plan as of May 1, 2014 and did not have health insurance in the months prior to 2014.

If you are approved for an exemption, it means you won’t have to pay a penalty to the irs for not having health insurance. however, it also means that you will have to pay the full cost of your medical care.

How do I apply for an affordability exemption if health coverage through a job is not affordable?

You can apply for an exemption if the health coverage available through a job is not affordable. This means that the cost of health coverage available through a job for you or your family is more than 8% of your household income.

you can:

  • Claim this exemption when you file your federal income tax return, or
  • Request the exemption using the form for people who want to request an exemption based on unaffordable coverage.

what if I don’t have health coverage through a job and can’t afford coverage through any health status?

If your job doesn’t offer coverage or you can’t afford health coverage through any health state, you can complete the form for people who want to apply for an exemption based on coverage not being affordable. You must provide more information with this form to see if you qualify for an exemption.

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Health coverage is considered unaffordable if the lowest-cost bronze plan available to you through any health state is more than 8.16% of your projected modified adjusted gross income after the advance tax credit has been applied for the premium (aptc) at the cost of the plan. To find out how much APTC you will receive and the cost of the lowest cost Bronze plan available, you must first apply for help paying for health coverage through any health state.

Follow the steps below to apply for the hardship waiver:

  1. apply for help paying for health coverage through any health state.
  2. make a copy of your eligibility determination notice showing your aptc maximum.
  3. from the plan “find a plan” screen from the selection section, click the “request an exemption” button. print the full page that includes the aptc maximum amount and cost information for the lowest cost bronze plan available to you.
  4. complete the form for people who want to apply for an exemption based on the coverage is not affordable.
  5. Follow the instructions on the form to submit the application and the appropriate documents.

what if I don’t file income taxes because my income is too low?

You do not need to apply for an exemption. This is true even if you file a return for a refund of money withheld from your paycheck. you will not have to make the shared responsibility payment. click here for information on submission limits.

how do I request another type of exemption (for reasons other than affordability)?

for exemptions based on:

  • membership in a health care sharing ministry,
  • membership in a federally recognized Indian tribe, or
  • being incarcerated

for exemptions based on:

  • membership in a recognized religious sect whose members are opposed to insurance,
  • eligibility for services through an Indian health care provider, or
  • experiencing hardship (which are not affordability difficulties)

for exemptions based on:

  • gap in coverage for less than three months
  • have coverage through an in-market or non-market health plan as of May 1, 2014 (and had no insurance doctor before May 1, 2014)
  • not be lawfully present in the united states

When will I know if I’ve been approved for a waiver?

If you claim an exemption when you file your federal income tax return, the IRS will notify you of the approval. If you applied for an exemption by completing any of the forms described above, the Federal Marketplace will notify you of approval (the exemption certificate number) or request more information if they are unable to process your application.

Please do not send your waiver application or materials to any health state. No health state accepts, processes, or approves waiver applications.

You can call the Federal Marketplace at 1-800-318-2596 about the status of your exemption request.

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