Proof of Lack of Minimum Essential Coverage (MEC)
Submit a copy of one of the following documents.
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Certificate of coverage or letter from the health insurance company showing the end date of coverage.
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Government-issued document showing date of termination of health insurance or ineligibility to program.
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Employer statement indicating no offer of affordable minimum value health insurance through your job.
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Self-attestation (legally signing a document yourself to confirm its authenticity), where the individual is unable to provide any of the above documents.
To show lack of Medicare eligibility or enrollment:
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Letter or statement from Medicare or the Social Security Administration stating that you or your family members are:
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Not eligible for or enrolled in premium-free Medicare Part A; or
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Eligible for (but not enrolled in) Part A coverage that requires monthly premium payments. Important: A Social Security document that shows you don’t pay a premium for “Medical Insurance” refers to Part B. It’s not acceptable for verifying eligibility for Part A; or
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No longer eligible for Social Security Disability Insurance (SSDI) benefits, and your coverage has ended or will end in the next 90 days.
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If you are unable to obtain this letter, you may complete and submit an Attestation of Medicare Eligibility and Enrollment Status form.
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