ACA Exemption Codes


  • Exemptions apply only to months not covered.
  • MEC for 1 day counts as covered for the entire month.
  • See also the AARP ACA Exemption Reference Guide for additional information

Coverage gap prior to obtaining MEC (2014 only):

G
  • Enrolled in marketplace beginning 5/1/2014 or earlier or
  • “In line” for marketplace coverage, even after 5/1/2014 or
H
  • Eligible for, but did not sign up for an employer plan that ends in 2014 or
  • Limited benefit Medicaid or TRICARE ending in 2014.

Short coverage gap:

B
  • Gap can only be for 1 or 2 months.
  • Cannot be used for 1-2 months of a larger gap.
  • If there was a gap at the end of the previous year, those months are considered part of the gap unless they were covered by a different exemption (i.e, not “B”).
  • Exemption B can only be used once each year.

Situational exemptions (for months that apply):

C
D
  • Members of a health care sharing ministry.
  • Members of certain religious sects (Marketplace exemption only)
E
F
  • Persons confined in jail, prison, or correctional facility for at least 1 day.
  • Does not include time in jail pending disposition of charges.
  • Does not include time in probation, parole or home confinement.
G
  • Moved to Colorado from a state that did not expand Medicaid and household income below 138% of the Federal Poverty Level
    2014 2015 2016
    138% Fed Poverty Level  $15,856 $16,105  $16,243
H
  • Member of the tax household born, adopted or died
  • Use this code if another exemption for the person is required for other months.

Coverage is unaffordable:

If no other code applies, check for unaffordable codes

A (individual) or

G (entire family).

See the ACA – Affordability resource page.

Hardship exemptions (from the marketplace only):

Complete the return using “PENDING” if they don’t have one. the taxpayer will have to apply to their exchange and then the IRS will resolve once the exemption has been issued. Get forms at: https://marketplace.cms.gov/applications-and-forms/exemption-applications.html.

  • Homelessness
  • Eviction in the last 6 months or facing eviction/foreclosure
  • Utility shut-off notice
  • Domestic violence
  • Recent death of a close family member
  • Disaster that resulted in significant property damage
  • Bankruptcy in the last 6 months
  • Debt from medical expenses in the last 24 months
  • High expenses caring for ill, disabled, or aging relative
  • Failure of another party to comply with a medical support order for a dependent child who is ineligible for Medicaid or CHIP
  • Eligible for a Marketplace QHP, PTC, or CSR but was not enrolled
  • Ineligible for Medicaid because state did not expand
  • Individual health insurance plan was cancelled and you believe Marketplace plans are considered unaffordable
  • Other hardship in obtaining coverage (including for people in AmeriCorps, VISTA and NCCC who are enrolled limited duration or self-funded coverage)