Beginning in 2014, all individuals must have health care coverage, have a health care coverage exemption, or pay a fee (tax penalty) if you file a federal income tax return. If the only health coverage you have is through the Indian Health Service and you do not have other insurance, such as through your employer, the Marketplace, or through a federal health program such as, Medicare, Medicaid, or VA, you will need to file for an Exemption to avoid paying any penalties. An Indian Exemption is available to members of federally recognized Tribes, Alaska Native Claims Settlement Act corporation shareholders, and other individuals eligible to receive services from an Indian health care provider. The Indian Exemption may be claimed on a federal tax return using Form 8965. If you have an Exemption Certificate Number (ECN) you can enter it on form 8965 but you can still claim the exemption using form 8965 even if you do not have an ECN.