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Health Care Exemption

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gqtsnyder

New member
I live in NC and I read in a few places that there were some additions to the exemptions for the 2017 and 2018 tax period. One of those was living in an area that only has one option for the health care marketplace. NC only has Blue Cross Blue Shield. However, I can't find anywhere that I can actually claim this exemption. When I use the online exemption link at the Marketplace website, there is no question about that and I am kicked off for not being exempt so I can't even download the form. Any tips? Thanks!
 


FlyingRon

Senior Member
You're going to have to explain things a little more. The fact that there's only one company in the registry doesn't exempt you. The fact you moved around doesn't exempt you. Being in jail, having low income, having certain other financial events, etc. do qualify you. The 20 questions on healthcare.gov is specifically asking you about things that might lead to the exemptions. If your answers cause it to tell you that you don't qualify, you probably do not.
 

gqtsnyder

New member
This is from hewalthinsurance.org and there were similar articles on NPR, etc.

"In addition to the situations that already counted as hardships, you can now get a hardship exemptions if you live in an area where there’s only one insurer offering plans in the exchange (or zero insurers, but that didn’t happen anywhere in 2018), or if the only available exchange plans cover abortion and you’re opposed to that. Hardship exemptions are also available if you “experience personal circumstances that create a hardship in obtaining health insurance coverage under a QHP,” because, for example, a specialist you need to see does not participate in the networks of any of the available exchange plans.
Source: https://www.healthinsurance.org/obamacare/obamacare-penalty-exemptions/
Follow us: @EyeOnInsurance on Twitter | healthinsurance.org on Facebook"

And this from the Department of Health and Human Service:

In accordance with 45 CFR §155.605(d)(1)(iii), the FFE may grant a hardship exemption when a person lives in a county, borough, or parish in which there is only one issuer offering coverage through the FFE for the current year and the person can show that the resulting lack of choice has precluded him or her from obtaining coverage under a QHP


Looks like I have to fill out a form and just explain it in words....
 

LdiJ

Senior Member
This is from hewalthinsurance.org and there were similar articles on NPR, etc.

"In addition to the situations that already counted as hardships, you can now get a hardship exemptions if you live in an area where there’s only one insurer offering plans in the exchange (or zero insurers, but that didn’t happen anywhere in 2018), or if the only available exchange plans cover abortion and you’re opposed to that. Hardship exemptions are also available if you “experience personal circumstances that create a hardship in obtaining health insurance coverage under a QHP,” because, for example, a specialist you need to see does not participate in the networks of any of the available exchange plans.
Source: https://www.healthinsurance.org/obamacare/obamacare-penalty-exemptions/
Follow us: @EyeOnInsurance on Twitter | healthinsurance.org on Facebook"

And this from the Department of Health and Human Service:

In accordance with 45 CFR §155.605(d)(1)(iii), the FFE may grant a hardship exemption when a person lives in a county, borough, or parish in which there is only one issuer offering coverage through the FFE for the current year and the person can show that the resulting lack of choice has precluded him or her from obtaining coverage under a QHP


Looks like I have to fill out a form and just explain it in words....
Actually, you don't even need to fill out a form for a hardship exemption for 2018. The IRS announced in late January or early February that it was no longer necessary to get permission for a hardship exemptions. You simply need to be able to prove the hardship if the IRS eventually asks you to do so.
 

gqtsnyder

New member
Nevermind, I found it. So if this is the case, then anyone in Buncombe County could claim this exemption on their taxes, right? Is that what the accountants are doing then?
 

FlyingRon

Senior Member
Again you've not shown that you are exempt. Understand that the passage you quoted isn't actually in the tax code. It's just an interpretation that this rule: "He or she has experienced other circumstances that prevented him or her from obtaining coverage under a qualified health plan. " may apply

You can't just drop out part of the sentence. The interpretation doesn't say that you're exempt if there's only one issuer. The second half says "can show that the resulting lack of choice has precluded them from obtaining coverage under a QHP."

So if you can show how that was only one issuer precluded you from getting coverage, you can claim the exemption. Otherwise, you owe the penalty.
 

Zigner

Senior Member, Non-Attorney
To boil it down: How did having only one issuer in your area prevent you from obtaining coverage?
 
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