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  • 2015 Exemption Application Form - Health Insurance Marketplace ...

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10/2014 Application for Exemption from the Shared Responsibility Payment for Individuals who are Unable to Afford Coverage and are in Certain States with a State-based Marketplace Use this application.

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If your income is below your minimum threshold for filing a federal income tax return, you are exempt from the individual shared responsibility provision and are not required to file a federal income tax return solely to claim the exemption.

Is there a penalty for not having insurance? There is no federal government penalty for being uninsured in 2021, but you still need coverage! The ACA's federal individual mandate penalty has been $0 since the start of 2019, and that will continue to be the case in 2021.

For 2015, the penalty for no health insurance is $325 per person or 2% of your annual household income whichever is higher. For 2016, the fee is $695 or 2.5% of your income whichever is higher. For many people, that's more than the yearly cost of health plans they can find on HealthCare.gov.

A number the Marketplace provides when you qualify for a health insurance exemption. When you fill out an exemption application, the Marketplace will review it and determine if you qualify. The Marketplace will mail you a notice of the exemption eligibility result.

In 2017 and 2018, the penalty increases to the greater of $695 per adult and $347.50 per child, plus COLA ( Cost of Living Adjustment ), or 2.5% of your taxable household income minus the federal tax-filing threshold. In 2019, there will be no more penalty.

Step 1: Identify the correct form for you. Right-click this exemption application form (PDF) link for hardship exemptions, like homelessness, bankruptcy, eviction, or foreclosure. ... Step 2: Download the form on your computer. Download the form on your computer. ... Step 3: Open the form and fill it out.

The penalty for not having coverage the entire year will be at least $750 per adult and $375 per dependent child under 18 in the household when you file your 2020 state income tax return in 2021.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232