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Hardship Exemptions

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There are certain circumstances that affect an individual’s ability to purchase health insurance coverage and which may qualify an individual for a hardship exemption. To make the determination, the Marketplace considers whether an individual has experienced one of the following events:

  1. Becomes homeless
  2. Has been evicted in the past six months, or is facing eviction or foreclosure
  3. Has received a shut-off notice from a utility company
  4. Recently experienced domestic violence
  5. Recently experienced the death of a close family member
  6. Recently experienced a fire, flood, or other natural or human-caused disaster  resulting in substantial damage to individual property
  7. Filed for bankruptcy in the last six months
  8. Incurred medical expenses in the last 24 months that resulted in substantial debt
  9. Experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member
  10. Expects to claim a child as a tax dependent who has been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, the individual would not have to make a payment for the child
  11. As a result of an eligibility appeals decision, is determined eligible for enrollment in a QHP through a Marketplace, the premium tax credit, or cost-sharing reductions for a period of time during which he or she was not enrolled in a QHP through a Marketplace
  12. Was determined ineligible for Medicaid because his or her state did not expand eligibility for Medicaid under the Affordable Care Act
  13. Lost insurance coverage because his or her individual plan was cancelled and believes other available coverage options are unaffordable
  14. Experiences another hardship in obtaining health insurance

Only individuals under age 30 and individuals with hardship exemptions may purchase a catastrophic plan. Catastrophic plans typically have high deductibles, and mainly protect individuals from very high medical costs.

Posted 10:33 AM  View Comments

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