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Vermont online Form 8965: What You Should Know

S. Citizen or your filing status is unknown to the Marketplace, ask the Marketplace staff to complete the Form 8965 for you. Filing the Form 8965—How to Get the Exemption Certificate Number (ECN) The Form 8965 is to calculate an Exemption Certificate Number (ECN). The ECN will be used to verify your eligibility to enroll in a Marketplace-granted qualifying health plan.  Use the Exemption Certificate Number to request to have the ECN updated in our system. The ECN is updated for you when we receive the new enrollment records from your Marketplace. You can view the ECN on the Marketplace website. ​ If your household income is too low to purchase a Marketplace-granted coverage exemption, but you also meet other income-related eligibility requirements, apply for or enroll in Medicare. The Form 8965, and Part I—the Marketplace-Granted Coverage Exemption Form, must be completed and submitted by October 15 for coverage beginning in 2017. Complete and submit Form 8965. If you're a dependent or an eligible family member of any qualifying member, you also must complete the Part IV, Part V—the Marketplace-Granted Coverage Exemption Certificate (ECC), and submit it to the Marketplace. It is important to know whether you have a Marketplace coverage exemption. If you don't have one, then you are currently not eligible to enroll in Medicaid or the Children's Health Insurance Program (CHIP) or the Low Income Health Incentive Cost Sharing Program (LI HCS), a coverage exemption that generally means your coverage will not be subsidized by the amount your family earns.​ Filing the Form 8965—How to Get the ECN After the completion of any required forms and instructions, mail or fax the completed Form 8965, and any attachments, to: Vermont Department of Taxes 12 Main Street P.O. Box 2000, Burlington VT 05402 If necessary, provide us with the documentation used to complete Part I—the Marketplace-Granted Coverage Exemption Form for the coverage period for which you are requesting an exemption.

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