October 2021

When creating a new account on HealthCare.gov, individuals are required to verify their identity by answering a series of questions based on information in their credit report, such as former addresses, the bank where they have a mortgage or auto loan, or the year they signed up for a specific credit card.

HealthCare.gov allows two attempts to verify identity, if the individual fails both attempts they will not be allowed to submit their application until their identity can be verified.

This guide outlines the steps you should take to troubleshoot a failed identity verification.

Additional Resources

OE9 Webinar: Part IV Preventing & Resolving Data Matching Issues

Reference Guide to Immigration Documents

Eligibility for subsidies in the Marketplace is determined in part by using specific percentages and thresholds that are indexed and change each enrollment year.

In addition, people who received advance premium tax credits (APTC) in the prior enrollment year will need to complete a tax return for that year and will need to use percentages and thresholds applicable to that tax year.

This reference guide lists all the indexed guidelines and thresholds that change each enrollment year.

Coverage Year 2022 / Tax Year 2021

September 2021

↓ View reference guide (PDF)

Coverage Year 2021 / Tax Year 2020

March 2021 (updated to reflect changes to premium tax credits in the American Rescue Plan)

↓ View reference guide (PDF)

Coverage Year 2020 / Tax Year 2019

October 2019

↓ View reference guide (PDF)

Coverage Year 2019 / Tax Year 2018

June 2018

↓ View reference guide (PDF)

Coverage Year 2018 / Tax Year 2017

November 2017

↓ View reference guide (PDF)

Updated September 2021

The Marketplace open enrollment period is the regular time each year when people can newly enroll in a qualified health plan or change to a different plan through the Marketplace. But certain events that occur during the year can trigger a special enrollment period (SEP), when a person may be able to newly enroll in a Marketplace plan or change to a different plan.

This SEP Reference Chart is a tool for those who are helping people enroll in health coverage through a special enrollment period. It focuses on the circumstances that trigger a SEP in the Marketplace, who can trigger a SEP, and the effective date of coverage once a health plan is selected.

Amid the COVID-19 pandemic, and the economic crisis that came about as a result, this abbreviated SEP Reference Chart provides a list of the most common SEPs used during this time.

People who missed their SEP window due to COVID-19 can still enroll in Marketplace coverage using the “FEMA SEP.” This fact sheet explains what the FEMA SEP is and how it works.

Additional Resources

Webinar: Special Enrollment Periods | View webinar

Minimum Essential Coverage Reference Chart | View chart

February 2021

Use this outreach resource to help inform people of the information they will need to bring with them to an enrollment appointment.

This will also help people who are enrolling on their own by informing them of the documents they should gather before beginning their application.

This resource is customizable. There is space at the bottom for you to add your organization’s name, contact information, and logo.

Outreach resource in English

Outreach resource in Spanish

Outreach resource in Simplified Chinese

Outreach resource in Korean

Outreach resource in Vietnamese

Outreach resource in Tagalog

Outreach resource in Russian

Outreach resource in Arabic

Updated September 2020

The health reform law changed the way Medicaid and CHIP determine eligibility for most beneficiaries to align with how eligibility for premium tax credits is determined in the Marketplaces.  All three coverage programs determine a household’s size and income using tax rules.  The Center on Budget and Policy Priorities developed The Health Care Assister’s Guide to Tax Rules to familiarize people who are helping consumers apply for Medicaid, CHIP and premium tax credits with the tax rules that are applied in determining eligibility for these programs.

The guide explains the basics of who must file taxes, different filing status options, rules for claiming tax dependents, rules for determining Medicaid and CHIP households and how these rules differ from rules for premium tax credit, as well as what sources of income are considered taxable and therefore counted in determining Medicaid and premium tax credit eligibility.  The guide is meant to give health care assisters a basic understanding of these rules to help guide discussions with applicants.

September 2020

Eligibility for the premium tax credit is based on certain tax rules determining filing status and who is included in a tax household.

This reference guide walks through the following:

• Who can be claimed as a tax dependent?
• Tax filing statuses and eligibility for the premium tax credit
• Rules to file as head of household

Additional Resources

Webinar OE8: Determining Households and Income for the PTC and Medicaid

Guide: The Health Care Assister’s Guide to Tax Rules

Updated July 2020

We have created a tool to help you estimate the income and expenses a self-employed client needs to include on their HealthCare.gov application to project their income for the enrollment year.

This tool will give the client a ballpark estimate of their projected net self-employment income.

There’s no need to print this worksheet. You can fill the worksheet out on your computer as a PDF and email the completed worksheet to your client.

Click here for the self-employment income estimator tool

December 2019

This guide explains eligibility rules for individuals with offers of employer-sponsored coverage. It covers how to determine whether employer-sponsored coverage is affordable and minimum value, as well as special rules that reduce an employee’s required contribution.

The guide also offers details and examples on how ICHRAs and QSEHRAs work with marketplace plans.

Click here for the Employer Coverage & Premium Tax Credit Eligibility guide 

Additional Resources

Webinar OE7: Eligibility Rules for Premium Tax Credits

Guide: The Health Care Assister’s Guide to Tax Rules

California

October 15, 2018 – January 15, 2019

Colorado

November 1, 2018 – January 15, 2019

Connecticut

November 1, 2018 – December 15, 2018 (not extended)

District of Columbia

November 1, 2018 – January 31, 2019

Idaho

November 1, 2018 – December 15, 2018 (not extended)

Maryland

November 1, 2018 – December 15, 2018 (not extended)

Massachusetts

November 1, 2018 – January 23, 2019

Minnesota

November 1, 2018 – January 13, 2019

New York

November 1, 2018 – January 31, 2019

Rhode Island

November 1, 2018 – December 31, 2018

Vermont

November 1, 2018 – December 15, 2018 (not extended)

Washington

November 1, 2018 – December 15, 2018 (not extended)

October 2019

Medicaid eligibility based on modified adjusted gross income (MAGI) household and income rules uses three categories to determine an individual’s household size:

• Tax filers not claimed as a tax dependent
• Tax dependents (with three exceptions)
• Non-filers not claimed as a tax dependent

Separate determinations of household size are made for each member of a family, and the categories are based on expected filing status. MAGI rules apply to children, pregnant women, parents and caretaker relatives, and adults in states that have expanded Medicaid eligibility. Seniors and people eligible for Medicaid based on a disability use different household and income rules.

This reference guide walks through the Medicaid household rules for MAGI Medicaid eligibility.

Additional Resources

OE7 Webinar: Determining Households and Income for the PTC and Medicaid

Guide: The Health Care Assister’s Guide to Tax Rules