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The Wagner Law Group Description 

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 


Established in 1996, The Wagner Law Group has 22 attorneys engaged exclusively in employee benefits, estate planning and employment law. Six of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.






Contact Info

The Wagner Law Group


  Integrity | Excellence


Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

Florida Office 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418


San Francisco Office

Tel: (415) 625-0002

Fax: (415) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104







March 20, 2015


 Health and Welfare Law Alert




 IRS Issues Guidance on ACA's Individual Mandate Exemptions




The IRS has released guidance on the various exemptions from the Affordable Care Act's individual shared responsibility requirement. IRS Fact Sheet 2015-14 highlights some of the available exemptions, and explains procedures for claiming them.


Background. Under the ACA's individual shared responsibility provisions, taxpayers must either obtain qualifying health care coverage or make an individual shared responsibility payment when filing their federal tax returns. However, certain taxpayers qualify for an exemption from this requirement.


Health Coverage Exemptions. The following is a partial list of available exemptions: 

  • Unaffordable coverage - Coverage is considered unaffordable if the lowest premium amount for available, employer-sponsored coverage, or for coverage through the Health Insurance Marketplace ("Marketplace"), is more than eight percent of household income for that year.
  • Short coverage gap - The taxpayer went without coverage for less than three consecutive months during the year.
  • General hardship - Certain circumstances prevent the taxpayer from obtaining coverage under a qualified health plan, including homelessness, eviction, foreclosure, domestic violence, death of a family member and unpaid medical bills.
  • Income below return filing threshold - The taxpayer's household or gross income is below the minimum threshold for filing a tax return.
  • Certain noncitizens - The ACA's individual shared responsibility provisions do not apply to individuals who are not U.S. citizens and who are not lawfully present in the U.S.
  • Residents of a state that did not expand Medicaid - The taxpayer is determined to be ineligible for Medicaid because he or she resides in a state that does not participate in the ACA's Medicaid expansion.
  • Members of Indian tribes - The taxpayer is a member of a federally-recognized Indian tribe or is otherwise eligible for services through an Indian health care provider or Indian Health Service.

Obtaining a Coverage Exemption. Certain health coverage exemptions must be obtained by applying for the exemption through a Marketplace and some exemptions must be claimed on a federal tax return. However, an individual whose income is below the minimum threshold for filing a federal income tax return is automatically exempt from the individual shared responsibility provision and need not file a federal income tax return to claim the exemption.


Reporting the Coverage Exemption. Taxpayers must claim health coverage exemptions on Form 8965, "Health Coverage Exemptions," and attach it to their Form 1040. These forms can be filed electronically. Taxpayers who are granted an exemption from a Marketplace will receive a exemption certificate number ("ECN"), which must be entered in Part I of Form 8965, in Column C.


Taxpayers who file a tax return despite having a gross income below the filing threshold must claim a health coverage exemption using Part II of Form 8965. All other health coverage exemptions are claimed in Part III of Form 8965.


A complete list of exemptions with information on whether taxpayers obtain them from the IRS or the Marketplace is available at: http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Exemptions







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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.