Most people who enroll in health insurance through the marketplace are eligible for financial help. Premium tax credits lower up-front monthly premiums and cost-sharing reductions lower deductibles, copayments, and other costs when people use their insurance.
Determining household size and accurately calculating income are key to determining whether someone is eligible for Medicaid or financial help in the marketplace. Tools to calculate income and self-employment earnings can help people complete their applications.
Certain circumstances, like having an offer of employer-sponsored insurance, might disqualify someone from financial help.
In this Beyond the Basics webinar presented on September 8, 2022, Jenny Sullivan, Director of Health Coverage Access, covers the rules used to determine household size and explain what counts as income when determining eligibility for premium tax credits and Medicaid.
In this Beyond the Basics webinar presented in partnership with the National Immigration Law Center (NILC) on September 19, 2023, Gabrielle Lessard, Senior Policy Attorney at NILC, and Shelby Gonzales, Vice President for Immigration Policy at the Center on Budget and Policy Priorities, provide an overview of immigration-related eligibility requirements…
This worksheet will help individuals add up their current monthly income and estimate their annual income for the following year. It will be particularly useful for people with multiple sources of income. This is a fillable worksheet, which means you can fill it out on your computer and email it…
In this Beyond the Basics webinar presented on September 14, 2023, Jenny Sullivan, Director of Health Coverage Access, provided an in-depth review of eligibility rules for premium tax credits as well as how premium tax credits are calculated. Webinar Resources ↓ Presentation Slides (PDF)
In this Beyond the Basics webinar presented on September 12, 2023, Jenny Sullivan, Director of Health Coverage Access, and Allison Orris, Senior Fellow on the Health Policy Team, cover the rules used to determine household size and explain what counts as income when determining eligibility for premium tax credits and…
Updated September 2023 This Employer Coverage & Premium Tax Credit Eligibility 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…
Updated September 2023 ↓ Download PDF In general, an individual must not be eligible for minimum essential coverage (MEC) to be eligible for premium tax credits (PTC) in the marketplace, although there are a few exceptions. Being eligible for MEC means the insurance is available to the individual, even if they…
Financial eligibility for most categories of Medicaid and the Children’s Health Insurance Program (CHIP) is determined using a tax-based measure of income called modified adjusted gross income (MAGI). The MAGI methodology includes rules prescribing who must be included in a household when determining eligibility. The following FAQ explains MAGI and…
Updated August 2023 Financial eligibility for the premium tax credit, most categories of Medicaid, and the Children’s Health Insurance Program (CHIP) is determined using a tax-based measure of income called modified adjusted gross income (MAGI). The following Q&A explains what income is included in MAGI. Note that many guidelines and…
Updated August 2023 Millions of uninsured Americans are eligible for a premium tax credit to help them pay for health coverage. The premium tax credit is only available to people without another offer of affordable and adequate coverage; in most cases, this will mean that people with an offer of…
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…
