Help Paying Marketplace Premiums: Defining Income and Household

How do I apply for subsidies if I don’t know what my income will be next year?

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When you apply for the premium tax credit, you will be asked to estimate your expected income for the upcoming year. Often a good place to start is to consider what your income is this year, or what income you reported on your tax return last year. However, if your circumstances have changed since then (for example, if you recently lost your job), you should make your best estimate of what your income will be next year, including the unemployment benefits you expect to collect in 2025.

The health insurance Marketplace will compare your income estimates against records at the Internal Revenue Service, Social Security Administration, and other sources. If the income amount shown on that official record is more than 50% or $12,000 (whichever is greater) higher than the amount you put on your application, you might receive a data match inconsistency notice from the Marketplace and you’ll need to provide more documentation.

If you don’t have that documentation handy, the Marketplace will provide subsidies for up to 90 days while you gather and submit your documentation for verification. If you need an extension, the Marketplace will grant you an automatic 60-day extension to gather documentation confirming income. It is very important that you provide any documentation requested by the Marketplace in a timely manner; if you don’t, your subsidies might be reduced or terminated.

Keep in mind that if you estimate your income incorrectly and end up claiming more help than you are eligible for, you may have to pay back some or all of the premium tax credit you received. If you overestimate your income and end up claiming less help than you are entitled to, the difference will be refunded to you when you file your income taxes the following year.

State based Marketplaces may have their own standards around estimating income and timelines for submitting documentation to resolve a data match inconsistency. If you reside in a State-based Marketplace, click here for the link that will take you to the website for your State-based Marketplace. If you are unsure if you reside in a State-based Marketplace or a state where the Marketplace is offered on the federal platform (also known as a Healthcare.gov state or a State-based Marketplace-Federal Platform), click here for more information. Additionally, a link provided here can give you more information on how to estimate your expected income.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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