How to file a waiver for not having health insurance in California

[Cynthiad66]

You can get an exemption so that you won’t have to pay a penalty for not having qualifying health insurance.

Some exemptions require an exemption application through Covered California. Other exemptions do not require an application – instead, you can claim them when you file your state tax return.

Exemptions You Can Claim When You File State Taxes

• Income below the state tax filing threshold (you may still choose to file taxes and are required to if you received financial help).
• A short coverage gap of three consecutive months or less.
• Health coverage is unaffordable, based on actual income reported on your state income tax return when filing taxes.
  • Individual: Cost of the lowest-cost Bronze plan through Covered California or the lowest cost employer-sponsored employee-only plan is more than 8.27 percent of income (in 2021) on the tax return.
  • Household: Cost of the lowest-cost employer-sponsored family plan that covers all employee’s dependents is more than 8.27 percent of income (in 2021) on the tax return.
• Certain non-citizens who are not lawfully present.
• Citizens living abroad or residents of another state.
• Members of a health care sharing ministry.
• Members of federally recognized tribes including Alaskan Natives, or other individuals eligible for services through an Indian health care provider or the Indian Health Service.
• Incarceration (in jail – other than incarceration pending the disposition of charges).
• Enrolled in limited or restricted-scope Medi-Cal or other similar coverage.

To learn more, please visit the California Franchise Tax Board.

Exemptions You Can Apply for Through Covered California

• General Hardship
• Affordability Hardship
• Religious Conscience

You can only apply for a Covered California exemption for tax years 2020 and later. If you and all members of your tax household are not required to file a state income tax return, you do not need to apply for an exemption. If you are not sure if you are required to file, you may want to apply for an exemption anyway.

How to Apply

To apply for an exemption, you must provide all required information and acceptable proof for you and your tax household. Requirements are explained in the application for each exemption type.

You can submit your application online, by fax, or by mail. Information on how to submit is found at the end of the application. If you need help with your application, call (800) 300-1506.

What to Expect

Once you have submitted a complete exemption application, Covered California has up to 30 calendar days to determine whether you qualify. We will mail you a notice with our decision. The notice could show that your exemption was:

• Approved;
• Denied; or
• Had missing or inconsistent information and what steps to take.

Since exemptions are granted individually, the notice could also show that some individuals were approved for an exemption and some were denied.

What to Do with Your Exemption

Use the exemption certificate number (ECN) provided by Covered California in the exemption approval notice when you complete your state taxes. This number is needed on Form FTB 3853, Health Coverage Exemptions and Individual Shared Responsibility Penalty, to prove that Covered California granted you an exemption from the penalty.

How to Appeal a Decision

If you disagree with our decision about your eligibility for an exemption you can file an appeal or a complaint. You have 90 days from the date of your exemption notice to ask for an appeal.

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You can get an exemption so that you won’t have to pay a penalty for not having qualifying health insurance.

Some exemptions require an exemption application through Covered California.

Other exemptions do not require an application – instead, you can claim them when you file your state tax return.

There are several major changes to California health insurance in 2020:

• The California health insurance mandate is in effect, requiring Californians to have health insurance
• The California health insurance penalty is reinstated, which means most Californians who choose not to buy qualified health insurance will face a tax penalty

Starting in 2020, California residents must either:

• Have qualifying health insurance coverage, or
• Pay a penalty when filing a state tax return, or
• Get an exemption from the requirement to have coverage.

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. A family of four that goes uninsured for the whole year would face a penalty of at least $2,250.

The penalty will be applied by the California Franchise Tax Board. For information about the penalty, including the amount your family could owe for not having coverage, visit the Franchise Tax Board’s website and use their Penalty Estimator Tool.

[nataliacanada]

Hello,

My domestic partner and I have a situation related to this. 

Prior to our domestic partnership (which started Dec'22), he was foregoing health insurance since it was unaffordable based on projected income. His penalty was usually quite low so it made financial sense to do this. However now that we're filing taxes together, given the dual income, the penalty has become significant. 

Is it possible to get an exception, based on affordability related to projected income, prior to our domestic partnership starting? When consulting Covered California they highlight they can only do exceptions looking into the future, and that for previous months should just be claimed on tax return. What would be the best path forward?

[HopeS]

As a California resident, you should carry insurance throughout the year with no gaps in coverage of 90 days or more. Otherwise, you may face a tax penalty when you file your tax return.

To see if you qualify for any exemption please review the link provided or call 800-300-1506.

Health Care Exemption

@nataliacanada