By Kyle Maziarz
Open Enrollment for 2024 is in full swing, and due to a brief growth of federal premium subsidies, most Marketplace enrollees qualify for protection at a really low month-to-month price. This week, we’re highlighting regularly requested questions (FAQs) from our Navigator Resource Guide concerning the monetary help obtainable by the Marketplace.
Who is eligible for Marketplace premium tax credit?
Premium tax credit can be found to U.S. residents and lawfully current immigrants who buy protection within the Marketplace. In normal, people should even have family revenue above 100% of the federal poverty stage. Premium tax credit are additionally obtainable to lawfully residing immigrants with incomes beneath 100% of the poverty line who will not be eligible for Medicaid due to their immigration standing. (Generally, immigrants should lawfully reside within the U.S. for 5 years earlier than they’ll turn out to be eligible for Medicaid. However, states have the choice to waive the 5-year ready interval for kids and being pregnant protection. See our state truth sheets for particulars.)
In addition, to be eligible for the premium tax credit, people should not be eligible for public protection—together with most Medicaid, most Children’s Health Insurance Program protection, Medicare, or army protection—and should not have entry to inexpensive, enough medical insurance by an employer. There are exceptions. For instance, there may be an exception in instances when the employer plan is unaffordable as a result of the worker’s share of the premium exceeds 8.39 p.c of the worker’s family revenue in 2024 (for 2023, it was 9.12 p.c). There can also be an exception in instances the place the employer plan doesn’t meet a minimal worth (the plan should cowl at the least 60 p.c of the price of lined companies for the standard inhabitants, and it should embody substantial protection of doctor and inpatient hospital companies). (26 C.F.R. 1.36B-6; 26 U.S.C. §36B; IRS Revenue Procedure 2023-29.)
What revenue is counted in figuring out my eligibility for premium tax credit?
Eligibility for premium tax credit is predicated in your anticipated family revenue for the 12 months during which you’re making use of for protection. For instance, in case you are making use of for protection to begin in January 2024, it’s best to estimate your projected revenue for 2024.
The Marketplace assesses your Modified Adjusted Gross Income, or MAGI, to find out your eligibility for premium tax credit. When you file a federal revenue tax return, it’s essential to report your adjusted gross revenue (which incorporates wages and salaries, curiosity and dividends, unemployment advantages, and several other different sources of revenue). MAGI modifies your adjusted gross revenue by including to it any non-taxable Social Security advantages you obtain, any tax-exempt curiosity you earn, and any international revenue you earned that was excluded out of your revenue for tax functions.
To study extra about what particulars to incorporate in your family revenue estimate, see HealthCare.gov’s desk on what to incorporate in your revenue estimate.
Note that eligibility for Medicaid and CHIP can also be based mostly on MAGI (until you qualify on the idea of incapacity or are dually eligible for Medicare) , though some further modifications could also be made in figuring out eligibility for these packages. Contact your Marketplace or your state Medicaid program for extra info. (26 C.F.R. § 1.36B-1; IRS, Questions and Answers on the Premium Tax Credit.)
I can’t afford to pay a lot for deductibles and co-pays. Is there assist for me within the Marketplace for cost-sharing?
Yes. If your revenue is between 100% and 250 p.c of the federal poverty stage, it’s possible you’ll qualify for cost-sharing reductions along with premium tax credit. These will cut back the deductibles, co-pays, and different cost-sharing that may in any other case apply to lined companies.
The cost-sharing reductions can be found by modified variations of silver plans which can be provided on the Marketplace. These plans could have decrease deductibles, co-pays, coinsurance and out-of-pocket limits in comparison with common silver plans. Once the Marketplace determines you’re eligible for cost-sharing reductions, it is possible for you to to pick one in every of these modified silver plans, based mostly in your revenue stage. (45 C.F.R. § 155.305.)
Look out for added FAQs of the week all through Open Enrollment, and take a look at the Navigator Resource Guide for much more FAQs and different useful sources.