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.
Generally, people can only enroll in a marketplace plan or switch plans on HealthCare.gov during the annual open enrollment period. But people who experience certain life events during the year are able to newly enroll in a plan or switch plans outside of open enrollment through a special enrollment period…
The Inflation Reduction Act extends the increased marketplace premium subsidies that were enacted by the American Rescue Plan Act through 2025. With the increased premium subsidies in effect, monthly premium payments are lower and many more people can enroll in a marketplace plan at low or no cost. This FAQ…
Household size is a key factor in determining eligibility for the premium tax credit. The following Q&A explains the rules on household size and how it affects eligibility for and the amount of the premium tax credit. Note that many guidelines and thresholds are indexed and change each enrollment year.…
A new Treasury regulation finalized in October 2022 changes the rules used to determine whether an offer of employer-sponsored coverage is affordable to the spouse and dependents of an employee. These changes make many more people eligible for the premium tax credit (PTC), which can be used to purchase coverage…
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 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 don’t enroll in it. Therefore,…
This calculator provides an estimate of the amount of financial help a person may be eligible for and how much they could expect to pay for health insurance on the marketplace. The information provided is reflects the increase to premium tax credits in the American Rescue Plan and the Inflation Reduction…
In Part VIII of this Beyond the Basics OE10 webinar series presented on October 13, 2022, Claire Heyison, Senior Policy Analyst for Health Insurance & Marketplace Policy, and Jenny Sullivan, Director of Health Coverage Access, bring together all of the policies covered in the Beyond the Basics webinar series by…
Updated October 2022 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…
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 details and examples…
