Affordable Care Act

Can I adjust the level of subsidy I collect in advance during the year when my income goes up or down? How often during the year can I make adjustments?

Jul 15, 2020

FAQs

Yes, you can make adjustments during the year whenever you need to. There is no limit to the number of times a person may report income, family or insurance-eligibility changes to the Marketplace. Changes that are reported by enrollees will be verified by the Marketplace.

What’s the most I would have to repay the IRS?

Jul 15, 2020

FAQs

For the 2024 tax year, if you underestimated your income and received a larger tax credit than you were eligible for, you must repay the difference between the amount of premium tax credit you received and the amount you were eligible for.

I estimate my income next year will be very low, so I need a premium tax credit and I need to have it all paid in advance. If, by the end of the year, it turns out my annual income was even lower than I expected and I could have enrolled in Medicaid, will I have to pay back the premium subsidy?

Jul 15, 2020

FAQs

No, your final premium credit amount will be determined based on your income for the year as reported on your tax return. The fact that it ended up being less than you expected does not mean you have to pay back the premium tax credit you received.

I enrolled in a Marketplace policy with premium tax credits for 2025, even though my employer offers health benefits, because the employer coverage was unaffordable (more than 9.02% of my projected income in 2025). Then mid-year I started a second part-time job. As a result, my annual income will be higher than I originally estimated, and, at this higher income, the cost of enrolling in my job-based plan would be less than 9.02% of my income. Unfortunately, I can’t sign up for my employer plan until the next open season. What should I do? When I file my taxes will I be required to pay back my premium tax credits because I had access to affordable job-based coverage after all?

Jul 15, 2020

FAQs

First, you should report your income change to the Marketplace. The Marketplace will determine your new eligibility for premium tax credits, based on your higher income, and adjust the level of subsidy going forward.

I can’t afford to pay much for deductibles and co-pays. Is there help for me in the Marketplace for cost sharing?

Jul 15, 2020

FAQs

Yes. If your household income is between 100% and 250% of the federal poverty level (that's an annual income of $15,060 to $37,650 for a single person in 2025, or $25,820 to $64,550 for a family of 3), you can also qualify for cost-sharing reductions if you choose a Silver plan.

If I use my premium subsidy for a Bronze plan, I can save even more money on the premium. Can I get also get my cost-sharing reduction through a Bronze plan?

Jul 15, 2020

FAQs

No, you can only get cost-sharing reductions by enrolling in a Silver Marketplace plan. You will not receive cost-sharing reductions if you enroll in a Bronze, Gold, or Platinum plan. Note that this is different from the rule for premium tax credits. You can apply premium tax credits to all four types of plans.

How much are the cost-sharing reductions?

Jul 15, 2020

FAQs

That depends on your household income and where you live. To give a general idea, a typical Silver plan might have an annual out of pocket limit on all cost sharing of about $9,200.

If I mis-estimate my income and end up earning more than 250% of the federal poverty level next year, will I have to pay back the cost sharing subsidies?

Jul 15, 2020

FAQs

No. Unlike premium tax credits, which are reconciled each year based on the income you actually earned, cost-sharing reductions are not reconciled.

Can I be charged higher premiums in the Marketplace if I smoke?

Jul 15, 2020

FAQs

In most states, yes. Generally, an insurer can charge as much as 50% more for a person who uses tobacco products.

What does it mean to “use tobacco?” Do e-cigarettes count?

Jul 15, 2020

FAQs

“Tobacco use” means a person has used a tobacco product an average or four or more times per week for the past six months. A state can increase the number of times per week or reduce the “look-back” period to less than six months. Check with your state Marketplace to learn more.

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