Early Retirees

When can I apply for Marketplace premium tax credits when other coverage is available?

In general, if you have, or are eligible for, any of the following types of coverage, you would be ineligible for premium tax credits through the Marketplace:

  • Employer-sponsored coverage, unless the coverage is unaffordable (your required contribution to the premium for self-only coverage in 2020  costs more than 9.78% of household income) or does not meet minimum value (an actuarial value of less than 60%).  Special rules apply when the affordability of family coverage is a concern.
  • Government-sponsored coverage, including Medicare Part A coverage, Medicare Advantage plans, Medicaid coverage and the Children’s Health Insurance Program coverage, Veterans health coverage and TRICARE (coverage for members of the military)
  • Coverage for Peace Corps volunteers

However, if you have access to other types of coverage, you can still be eligible for premium tax credits, assuming you meet other requirements:

  • Individual (non-group) health insurance
  • Student health coverage
  • Coverage as a dependent under your parent’s group health plan if you are under age 26 and not claimed as a tax dependent by your parent
  • Retiree health coverage offered by a former employer
  • COBRA coverage

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.