Instructions For Form 8965 - Health Coverage Exemptions

Types of Minimum Essential Coverage

Minimum essential coverage means health care coverage under any of the following programs. It doesn’t, however, include coverage

consisting solely of excepted benefits. Excepted benefits include stand-alone vision and dental plans, workers' compensation cover-

age, and coverage limited to a specified disease or illness.

Employer-sponsored coverage:

Group health insurance coverage for employees under:

A plan or coverage offered in the small or large group market within a state,

A plan provided by a governmental employer, such as the Federal Employees Health Benefits program, or

A grandfathered health plan offered in a group market.

A self-insured health plan for employees,

COBRA coverage,

Retiree coverage,

Coverage under an expatriate health plan for employees and related individuals, or

Department of Defense Nonappropriated Fund Health Benefits Program.

Individual market coverage:

Health insurance you purchase directly from an insurance company,

Health insurance you purchase through the Marketplace,

Health insurance provided through a student health plan,

Catastrophic coverage, or

Coverage under an expatriate health plan for non-employees such as students and missionaries.

Coverage under government-sponsored programs:

Medicare Part A coverage,

Medicare Advantage plans,

Most Medicaid coverage,*

Children's Health Insurance Program (CHIP) coverage,

Most types of TRICARE coverage,

Comprehensive health care programs offered by the Department of Veterans Affairs,

Health coverage provided to Peace Corps volunteers,

Refugee Medical Assistance, or

Coverage through a Basic Health Program (BHP) standard health plan.

Other coverage:

Coverage under a group health plan provided through insurance regulated by a foreign government if (1) a covered individual is physically

absent from the United States for at least 1 day during the month, or (2) a covered individual is physically present in the United States for a full month

and coverage provides health benefits within the United States while the individual is on expatriate status,

Certain coverage provided to business owners who aren’t employees, or

Coverage recognized by HHS as minimum essential coverage, listed at

Market-Reforms/minimum-essential-coverage.html

(click on link for approved plans).

*Medicaid programs that provide limited benefits generally don't qualify as minimum essential coverage. However, individuals with certain types of limited-benefit

Medicaid coverage qualify for a coverage exemption. See the

Types of Coverage Exemptions

chart.

Lines 1–6

Coverage for business owners. Minimum essential cover-

age includes coverage provided to a business owner (such as a

Column (a)—Name of Individual

partner or sole proprietor) under a plan that is eligible employ-

Enter the name of each person in your tax household who was

er-sponsored coverage with respect to at least one employee.

granted a coverage exemption from the Marketplace or has an

application for a coverage exemption pending with the Market-

place. If the individual is listed on page 1 of your tax return, enter

Specific Instructions

the name exactly as it appears on your tax return.

Part I—Marketplace-Granted Coverage

Column (b)—Social Security Number (SSN)

Exemptions for Individuals

Enter the SSN of the individual listed in column (a). If the individ-

If you or another member of your tax household has been gran-

ual is listed on page 1 of your tax return, the SSN in this column

ted a coverage exemption for one or more months from the Mar-

should match the individual’s SSN listed on your tax return.

ketplace, or has an application for a coverage exemption for one

No SSN. If the individual listed in column (a) doesn’t have an

or more months pending with the Marketplace, complete Part I to

SSN, see the following options for how to complete column (b).

report these exemptions. Complete a line for each individual

IRS Individual Taxpayer Identification Number (ITIN)

who was granted or has a pending application for a Market-

for Aliens. If the individual listed in column (a) doesn't have and

place-granted coverage exemption. If an individual was granted

isn't eligible to get an SSN, enter the ITIN assigned to that per-

or has a pending application for more than one coverage exemp-

son by the IRS.

tion from the Marketplace, complete a separate line for each

Adoption Taxpayer Identification Number (ATIN). If the

coverage exemption for that individual. If you need more space,

individual was placed with you for legal adoption and you don't

attach a separate statement showing the information required in

know his or her SSN, enter the ATIN assigned to that individual

columns (a) through (c) for each additional coverage exemption.

by the IRS.

Coverage exemptions that apply to multiple years. If you

No identification number. If the individual listed in col-

were granted a coverage exemption that applies for multiple

umn (a) doesn't have an SSN, ITIN, ATIN, or other identification

years, you must report the coverage exemption on Form 8965

number from the IRS, leave column (b) blank for that individual.

every year it applies. See

Duration

under

Members of certain re-

ligious sects

and

Members of Indian

tribes, later.

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Instructions For Form 8965 - Health Coverage Exemptions - 2016 Page 5

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