What to do if you did not have health coverage for part or all of 2018

The Affordable Care Act (ACA) requires most Americans to

  • Have health coverage that qualifies as minimum essential coverage (MEC) ,
  • Get an exemption from having health coverage, or
  • Pay a penalty—or fee—or not having health coverage.

Examples of health coverage that qualifies as MEC include:

  • A Health Connector or ConnectorCare plan;
  • Insurance from a job, including COBRA;
  • Medicare Part A or Part C;
  • Most MassHealth coverage;
  • Most student health insurance plans;
  • Some other types of coverage recognized by the Secretary of the U.S. Department of Health and Human Services as minimum essential coverage (MEC) .
  • See a full list of what coverage qualifies as MEC →
If you didn’t have health coverage for all or part of 2018, you have to either qualify for a health coverage exemption or may have to pay a fee with your federal income tax return. If you had a short gap in coverage of less than 3 months, you do not have to pay the fee for any month.

See how to claim an exemption for a short coverage gap →

Exemptions

Because of national health care reform, most Americans must have health coverage that

  • Have health coverage that qualifies as minimum essential coverage (MEC) ,
  • Get an exemption from having health coverage, or
  • Pay a penalty—or fee—or not having health coverage.

Health coverage that qualifies for the federal requirement to have coverage includes:

Some people are exempt from the health coverage requirement such as individuals or households with incomes below the threshold for filing a federal tax return are automatically exempted. Others will have to file for the exemption on their taxes or through the federal government.

They include:

  • Those who would have to spend more than 8.13 percent of their yearly household income in 2018 to buy insurance;
  • Those who are incarcerated;
  • People who are not lawfully present (i.e., not a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S.).
  • There are many other exemptions that may apply to your or your family including hardship exemptions.
  • For more information please visit the IRS website to review Questions and Answers on the Individual Shared Responsibility Provision.

Do I qualify for a waiver/exemption from the federal shared responsibility requirement?

Apply for an exemption

Anyone who qualifies for a health coverage exemption will need to apply through the HealthCare.gov Marketplace or claim the exemption on his or her tax return. Individuals may need information to support their coverage exemption claim. This includes documentation to support a hardship, income documents, social security information, and household information.

If an exemption application is granted by the Marketplace, the applicant will receive a notice with a unique Exemption Certificate Number, also known as an ECN. The ECN will be entered in Part I of Form 8965, which must be filed with the tax return.

Individuals who do not currently have their ECN, but who have applied for an exemption through the Marketplace, should enter the word “PENDING” in the place of the ECN in Part I of Form 8965. If you are claiming an exemption on your tax return, you do not need an ECN.

If you did not have health insurance for 3 months or more during the year, and are eligible for an exemption, you will need to fill out Form 8965 BEFORE filing your taxes if you have not applied for an exemption already.

Go to HealthCare.gov for more information and apply for an exemption →

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Need help filing your taxes?

Many taxpayers qualify to have their federal and state income taxes prepared and filed for free. Find out where to get free tax filing information on the Massachusetts Department of Revenue website.

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