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
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:
- 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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