Starting in 2019, there is no Individual Mandate penalty in effect. This change was made at the federal level as part of the Tax Cuts and Jobs Act enacted in December 2017. But, there are many financial and health reasons for enrolling in a health plan.
If the health coverage available to you through a job or the NY State of Health Marketplace is unaffordable, and you still wish to enroll in coverage, you can apply for an affordability exemption.
The first step in determining whether you qualify for this exemption is to apply for help paying for your health coverage. The cost of health coverage is considered unaffordable if the cost of the lowest cost bronze plan available for you to purchase on the NY State of Health Marketplace minus your Advance Premium Tax Credit (APTC), if applicable, exceeds 8.27% of your projected modified adjusted gross income. To get your APTC amount and the cost of the lowest cost bronze plan available to you, you must first apply on the New York Marketplace for help paying for your health insurance.
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Follow the steps below to apply for the affordability exemption if you would like to enroll in catastrophic coverage:
- Apply for help paying for health insurance on the Marketplace.
- Make a copy of your Eligibility Determination notice that shows your maximum APTC.
- Use the Lowest Cost Bronze Plan table to determine the lowest cost health plan available in your county.
- Complete the Affordability (State Based Marketplace, SBM) application that can be found here: https://marketplace.cms.gov/applications-and-forms/exemption-applications.html.
- Follow the directions on the form to submit the application and appropriate documents.
NOTE that you DO NOT need to apply for an affordability exemption, unless you wish to enroll in catastrophic health coverage.