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okitkaeva
New Member

Can I claim health coverage exemption for both me and my husband if employer-offered coverage exceeds 8.16% of our annual income but it involved the opt-out payment?

We didn't have coverage for 9 consecutive months (Feb-Oct), my husband was unemployed, total 2017 income before taxes was $70,000, the cheapest coverage my employer offered was $372 for me and $435 for my spouse, total $807. The total annualized premium (or even 9months')--$7263--is higher than 8.16% of our income which is $5712. However, my employer was paying me $529 every month for not taking the employer-sponsored insurance believing I was covered through my husband's employer. $529/month for 10 months with that employer is factored into our annual income of $70,000. My husband lost his job at the end of January, so our coverage ended there until I changed jobs in November and picked up more affordable insurance for both of us. 

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Accepted Solutions

Can I claim health coverage exemption for both me and my husband if employer-offered coverage exceeds 8.16% of our annual income but it involved the opt-out payment?

 For an exemption for job-based insurance, the self-only plan is not more than 8.16% of your household income.  Therefore, you would not be eligible for the exemption.  Since the family plan is higher than 8.16% of your household income your husband may be eligible for the exemption based on the numbers you are providing.  

To apply for the exemption for your husband you will simply need to 

  1. Click Federal
  2. Health Insurance
  3. I'll Pick who had it and which months
  4. De-select the months you both did not have insurance click Continue
  5. Under Couldn't Afford Insurance put a check mark next to "Self Only Coverage for two or more household members was not affordable"
  6. Select the months it was not affordable for him
  7. You will get a screen that says your penalty has been waived for him. 

See Screenshot

From healthcare.gov

NOTE: It’s possible that an employee won’t be eligible for the exemption because the self-only plan available to them is affordable. But other members of the household could be eligible for the exemption if family coverage offered to them is unaffordable.https://www.healthcare.gov/exemptions-tool/#/results/2017/details/employer-affordability

**Say "Thanks" by clicking the thumb icon in a post
**Mark the post that answers your question by clicking on "Mark as Best Answer"

View solution in original post

2 Replies

Can I claim health coverage exemption for both me and my husband if employer-offered coverage exceeds 8.16% of our annual income but it involved the opt-out payment?

 For an exemption for job-based insurance, the self-only plan is not more than 8.16% of your household income.  Therefore, you would not be eligible for the exemption.  Since the family plan is higher than 8.16% of your household income your husband may be eligible for the exemption based on the numbers you are providing.  

To apply for the exemption for your husband you will simply need to 

  1. Click Federal
  2. Health Insurance
  3. I'll Pick who had it and which months
  4. De-select the months you both did not have insurance click Continue
  5. Under Couldn't Afford Insurance put a check mark next to "Self Only Coverage for two or more household members was not affordable"
  6. Select the months it was not affordable for him
  7. You will get a screen that says your penalty has been waived for him. 

See Screenshot

From healthcare.gov

NOTE: It’s possible that an employee won’t be eligible for the exemption because the self-only plan available to them is affordable. But other members of the household could be eligible for the exemption if family coverage offered to them is unaffordable.https://www.healthcare.gov/exemptions-tool/#/results/2017/details/employer-affordability

**Say "Thanks" by clicking the thumb icon in a post
**Mark the post that answers your question by clicking on "Mark as Best Answer"
okitkaeva
New Member

Can I claim health coverage exemption for both me and my husband if employer-offered coverage exceeds 8.16% of our annual income but it involved the opt-out payment?

Thank you! I was thinking this may be the case in my situation. One example in the instructions to form 8965 made me believe we may both qualify for an exemption, but I guess it's more applicable to 2 separate employer coverage offers:
"Example 1—Two offers of self-only coverage that together
are unaffordable. Justin and Sally are married, have no
dependents, and file a joint return. Justin is offered self-only coverage
through his employer at a cost of 6% of the household income
and is offered family coverage that would cover both Sally
and him at a cost of 10% of the household income. Sally is offered
self-only coverage through her employer at a cost of 5% of
the household income and isn't offered family coverage. Sally
and Justin both may claim the coverage exemption for two or
more members of a tax household whose combined cost of employer-sponsored
coverage is considered unaffordable because
the self-only coverage offered to Justin and Sally doesn't exceed
8.16% of the household income when tested individually, the
cost of family coverage exceeds 8.16% of the household income,
and the combined cost of the self-only coverage offered
to Justin and Sally exceeds 8.16% of the household income."

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