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Hardship Exemption

Because of the individual mandate under the Affordable Care Act, most people must pay a fee if they don't have health coverage that qualifies as "minimum essential coverage." One exception is based on showing that a "hardship" prevented them from becoming insured. If an individual is homeless, recently experienced domestic violence, experienced the death of a close family member, filed for bankruptcy in the last 6 months, or any of several other qualifiers, a “hardship exemption” from the penalty may apply. Hardship exemptions are usually provided for the month before the hardship, the months of the hardship, and the month after the hardship, including up to a full calendar year.

Episode Payment

Refers to a single price for all of the services needed by a patient for an entire episode of care.