If you notify the Marketplace of any change in circumstances as soon as they occur, the Marketplace may update the information used to determine the expected amount of the premium tax credit and adjust your prepayment amount. This adjustment reduces the likelihood of a significant difference between your initial payments and your actual premium tax credit. Changes in circumstances that may affect the amount of your actual premium tax credit include: You are eligible for the premium tax credit if you meet all of the following requirements: Note: The federal poverty guidelines — sometimes referred to as the “federal poverty line” or FMA — indicate an amount of income that counts as the poverty line for the year based on family size. The Department of Health and Human Services (HHS) establishes the federal poverty guideline each year. The government usually adjusts revenue limits each year to account for inflation. At the beginning of each calendar year, the Federal Register publishes a table reflecting these amounts. This information can also be found on the HHS website. HHS offers three federal guidelines on poverty: one for residents of the 48 contiguous states and D.C., one for Alaskans, and one for Hawaiians. For the purposes of the premium tax credit, eligibility for a given year is based on the most recent federal poverty guidelines published on the first day of the annual open registration period. For example, the 2018 tax credit is based on the 2017 LPF. For more information, see the instructions for Form 8962. To be eligible for a loan amount for a specific month, you must generally be enrolled in an eligible health plan through the Marketplace on the first day of that month. However, if a person enrolls in an eligible health insurance plan and registration comes into effect on the day of the person`s birth, adoption or placement for adoption or foster care, or on the day a court order takes effect, the person will be treated as registered from the first day of that month.
If there is only one silver plan, that plan will be treated as the second lowest silver plan. If the two silver plans with the lowest cost have identical premiums, this premium is the premium for the second lowest silver plan. An employer-sponsored plan offers a minimum value if the plan covers at least 60% of the total eligible costs for the services covered. The plan must also provide significant coverage for hospitalization and medical services. Starting in 2014, your employer will need to provide you with a document called a summary of benefits and coverage. This document will give you information about the benefits and coverage of your employer-sponsored plan, including whether the plan offers a minimum value. In addition, under the Fair Labour Standards Act, most employers will give employees a unique notice of their market options and their potential eligibility for a premium tax credit. This single notice contains information indicating whether the employer has a plan that offers a minimum value. (See Question 8 on what is included in household income.) The affordability test applies only to the portion of the annual self-coverage premiums and does not include additional costs for family insurance. If the employer offers multiple health insurance options, the affordability test applies to the most cost-effective option available to you that also meets the minimum value requirement.
If your employer offers wellness programs (including programs based on a health factor or requiring that the wellness incentive be earned), the affordability criterion is based on the premium you would pay if you received the maximum discount for smoking cessation programs and did not receive other discounts based on wellness programs. When you or a family member applies for Marketplace coverage, the Marketplace estimates the amount of the premium tax credit you may be able to claim for the tax year, using the information you provide about your family composition, projected household income, and other factors, such as .B. whether the people you register are eligible for other non-market coverage. Based on this estimate, you can decide whether you want all, some or none of your estimated loans to be paid directly to your insurance company in advance to reduce your monthly premiums. If you choose to have initial payments made on your behalf, you will need to file Form 8962 with your tax return to match the amount of advance payments with the premium tax credit you can claim based on your actual household income and family size, except for certain taxpayers whose 2020 CTA is higher than their 2020 CWP. For more information on the 2020 tax year, see the new section On coronavirus tax breaks on this page. For the purposes of the premium tax credit, your household income is your modified adjusted gross income plus the tax income of each other family member (see Question 6) who must file a federal income tax return. Modified adjusted gross income is the gross income adjusted on your federal income tax return plus any excluded foreign income, non-taxable social security benefits (including Level 1 railway retirement benefits), and tax-exempt interest received or accrued during the taxation year.
It does not include Supplementary Security Income (SSI). If the source of your income is in Puerto Rico or was actually related to the conduct of a business or business in Puerto Rico, the income is not included in your modified adjusted gross income and will not be used to determine your household income. This restriction applies specifically to the calculation of amended adjusted gross income for the purposes of the premium tax credit. For more information, see Publication 570. If you have already filed a return and have an excess premium tax credit, you do not need to file an amended tax return or take any other action. The IRS will refund any excess APTC you paid on your 2020 tax return. If you have an employer-sponsored plan, including retirement coverage, this is an essential minimum coverage, you are not eligible for the premium tax credit for your Marketplace coverage, even if the employer plan is prohibitive or does not offer a minimum value. You may be eligible for a premium tax credit for the coverage of another family member who subscribes to Marketplace coverage and is not enrolled in the Employer Plan. If you receive an ERS for retirees only, you will not be able to claim a premium tax credit for the months in which the HRA is provided to you. The Premium Tax Credit is a refundable tax credit designed to help eligible individuals and low- and middle-income families purchase health insurance through the Health Insurance Market, also known as the Exchange. The amount of your premium tax credit is based on a sliding scale.
Those with lower incomes will receive a larger loan to cover the cost of their insurance. When you purchase Marketplace insurance, you can set up the Marketplace to charge an estimated credit that is paid to your insurance company to reduce your monthly premium payments (premium tax credit or APTC advance payments). Or you can choose to get all the benefits of the credit when you file your tax return for the year. If you choose to have advance payments of the premium tax credit made on your behalf, match the amount paid in advance with the actual credit you charge when you file your tax return. .