In this Beyond the Basics webinar presented on September 14, 2021, Tara Straw, Director of Health Insurance and Marketplace Policy, and Jen Wagner, Director of Medicaid Eligibility and Enrollment, detail the rules used to determine household size and explain what counts as income when determining eligibility for premium tax credits and Medicaid.

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Jump to:

Why Household Size & Income Matter

• ACA Eligibility Overview
• How the federal poverty line (FPL) effects expected premium contribution

Why Tax Filing Status Matters

• Overview of tax filing statuses
• Marital status and premium tax credits (PTC)
• Head of household questions
• Exceptions to the joint filing requirement for PTC

Determining Households for Premium Tax Credits

• Types of tax dependents

Determining Households for MAGI Medicaid

• Medicaid household rules

What Counts as Income for PTC and Medicaid

• Modified Adjusted Gross Income (MAGI)
• Rules for counting income
• Tips for counting self-employment income

Annual vs Monthly Income Counting

• Entering monthly income
• Entering annual income

Examples of Combining Household & Income Rules to Determine Eligibility

Additional Resources

Yearly Income Guidelines and Thresholds

Medicaid Household Rules

Determining Households for Medicaid and CHIP

Determining Households for PTC

Income Definitions for Marketplace and Medicaid Coverage

Self-Employment Income Estimator Tool

Health Care Assister’s Guide to Tax Rules

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

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.

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Why does household size matter when calculating eligibility for the premium tax credit?

Eligibility for the premium tax credit is based on a family’s income as a percentage of the federal poverty line (FPL). The poverty line increases with household size. Table 1 shows the federal poverty guidelines for different household sizes in the 48 contiguous states and the District of Columbia. (Alaska and Hawaii each have their own federal poverty guidelines.) A family’s poverty line percentage is their annual income divided by the poverty line for their household size. For example, a married couple with two children earning $45,000 a year would divide their household income by the poverty line for a family of four — $26,200 in 2020 — to calculate their income at 172 percent of the federal poverty line. This puts them in the eligible income range for a premium tax credit and cost-sharing reduction. (For more information on cost-sharing reductions, see Key Facts: Cost-Sharing Reductions.)

Income as a percentage of the federal poverty line also sets the amount of premium tax credit a household is eligible to receive. Families at different income levels are expected to contribute different percentages of their income towards premiums (see Table 2), with higher income families paying a greater percentage of their income towards premiums than lower income families. The premium tax credit is determined by subtracting the premium contribution from the cost of a benchmark plan so as premium contributions rise, the premium tax credit is reduced. (For more information on how the premium tax credit is calculated, see Key Facts: The Premium Tax Credit.)

How does the marketplace establish household size to determine eligibility for the premium tax credit?

A person’s household for premium tax credit eligibility includes all the individuals on their tax return — the tax filer, the tax filer’s spouse (if married filing jointly), and any dependents. Everyone is included in the household, even family members who are not applying for coverage and those who are not eligible for a premium tax credit. For example:

• Maria and Simon are married and have one child, Elaine, whom they claim as a tax dependent. They have a tax household of three people and earn $35,000 a year (which is 161 percent of the poverty line in 2020). Elaine is eligible for the Children’s Health Insurance Program (CHIP), making her ineligible for a premium tax credit, but she’s still included in Maria and Simon’s household for determining premium tax credit eligibility.
• Suppose that Maria and Simon also have an older daughter, Cora, who is 22 and living at home with her parents. Cora just graduated from college and is working full-time. She cannot be claimed as a tax dependent by her parents and files her own taxes. Even though Cora lives with her family, she is a household of one for premium tax credit purposes because she cannot be claimed by her parents.

Who can be in a household together?

The composition of the household for premium tax credit purposes follows Internal Revenue Service (IRS) rules for filing status and dependents. For more information on tax rules, see The Health Assister’s Guide to Tax Rules.

How do you determine the household of married couples who file separate tax returns?

To be eligible for a premium tax credit, married couples must file a joint tax return. Married couples who file separate returns are not eligible for a premium tax credit, with the following exceptions:

• A married person qualifies to file as head of household. A person who is married but does not plan to file jointly with a spouse can sometimes qualify as Head of Household, a filing status that allows a person to be eligible for a premium tax credit, rather than Married Filing Separately, which does not. In general, a person can be Head of Household if he or she is unmarried or considered unmarried. A married person is considered unmarried if he or she will live apart from his or her spouse in the last six months of the tax year and pays more than half of the cost of keeping up the home for their dependent child.
• A married person is a survivor of domestic violence or abuse. A taxpayer who lives apart from his or her spouse and is unable or unwilling to file a joint tax return due to domestic violence will be deemed to satisfy the joint filing requirement by making an attestation on his or her tax return. Under this IRS rule, taxpayers may qualify for the premium tax credit despite having the tax filing status of married filing separately; or
• A married person has been abandoned by his or her spouse. . A taxpayer is still eligible for a premium tax credit despite filing separately if he or she has been abandoned by a spouse and certifies on the tax return that the spouse cannot be located after using “reasonable diligence.”

The household of a person who qualifies for one of these exceptions includes the person and anyone he or she claims as a dependent on the tax return.

Note also that married people who file as Head of Household are always eligible for a premium tax credits, but married people who are survivors of domestic abuse or have been abandoned by their spouse can only qualify for those exceptions for no more than three consecutive years. (For more information on these exceptions, see the IRS rules.)

Do family members have to enroll in the same plan to be included in the same premium tax credit? 

The tax household for premium credit eligibility is based on tax rules and doesn’t always align with insurers’ rules about who can enroll in the same plan. In the marketplace, people have the option to purchase individual or family policies. Typically, health insurers limit family plans to only immediate family members (e.g., parents and their children). That means that a member of a tax household may need to enroll in a separate plan if they aren’t the child of the taxpayer, even if they’re properly claimed as a dependent and part of the household for premium tax credit purposes. For example:

• Serena lives with her son, Jacob, and her aunt, Martha, who Serena supports. Serena is a tax filer and claims both Jacob and Martha as tax dependents. Because most insurers wouldn’t include Martha in a family plan covering Serena and Jacob, Martha will be in a separate health plan. However, even though they are covered through separate health plans, the family is still one tax unit, so their premium tax credit is determined as a household of three, and the advance payment of the premium tax credit (APTC) is applied proportionally to the two plans (see Figure 1).
• Even though part of the advance payment goes to Martha’s health insurer during the year, Serena will claim the tax credit and be responsible for reconciling the entire household’s APTC, including Martha’s portion. Because Martha is a tax dependent, not a tax filer, she cannot directly claim a premium tax credit.

FIGURE 1: Example Allocation of APTC If Multiple Plans Cover One Household
Household of 3 (SERENA, JACOB, MARTHA)
Plan A Enrollees: SERENA and JACOB	Plan B Enrollees: MARTHA

On the other hand, insurers are required to allow taxpayers’ children under age 26 to enroll in their parents’ plan, even if they are not dependents and have a separate tax household. In these cases, the IRS has established rules for how to allocate advance payments of the premium tax credit. For example:

• Brian and Anika are married and file taxes jointly. Their 23-year-old daughter, Olivia, is not a dependent and files her own tax return. Even though Olivia is in a different tax household from her parents, she can enroll in a plan with them because she is under 26 years old. However, even if they enroll in a family plan together, the premium tax credit amount will be determined separately for each tax household (see Figure 2). Brian and Anika’s premium tax credit will be based on their income as a household of two. Olivia’s premium tax credit will be based on her income as a single household member.
• At tax time, Brian and Anika would file a tax return and reconcile their APTC amount and Olivia would file her own tax return and reconcile her APTC amount.

For a non-dependent child like Olivia, her share of the premium and her premium tax credit amount do not vary based on whether she enrolls in a plan together with or separately from her parents. In either case, the premium Olivia owes will be based on her age, location, and smoking status, and her tax credit will be determined by her income. Having a non-dependent enroll together with other family members also makes reconciliation of the credit more complicated. Given that, even though it’s permitted, there aren’t many benefits to enrolling people from separate tax households into the same marketplace policy.

FIGURE 2: Example Plans and APTC If Multiple Households in One Family

Household of 2 (BRIAN, ANIKA); Household of 1 (OLIVIA)

Plan A Enrollees: BRIAN, ANIKA, and OLIVIA

How do mid-year changes in a person’s household affect premium tax credit eligibility?

A change in household size affects the household income level as a percentage of the poverty line, changing the premium tax credit the taxpayer is eligible to receive. Since the premium tax credit is based on annual income, the change in household size affects the premium tax credit amount for the entire year, not just for the months after the change occurs. For example:

• A married couple with a projected income of $34,500 has income at 200 percent of the poverty line. If they have a baby sometime during the year they become a household of three and their income would be 159 percent of the poverty line. This change in poverty level income will lower the household’s expected contribution from 6.52 percent to 4.57 percent of income, which will make them eligible for a larger credit.

To ensure that individuals receive the correct premium tax credit for the year, household size and other changes should be immediately reported to the marketplace.

Are premium tax credit and Medicaid households the same?

No. For the premium tax credit, members of a tax household are always in the same household when determining their eligibility. For Medicaid, household size and composition are determined separately for each member of the household. The rules look at more than just tax filing status; familial relationships and who physically lives in a household are also part of the determination. In some cases, Medicaid follows the premium tax household rules, but in some cases it will not.

In addition, household rules for the premium tax credit are uniform across all states, but Medicaid provides some state options — such as some flexibility in the age limits for the definition of a child — that result in variability in household size depending on the state. For more information on the Medicaid household rules, see Key Facts: Determining Household Size for Medicaid.

How will the marketplace determine whether to use Medicaid or premium tax credit household rules to determine eligibility? 

An applicant can’t be eligible for a premium tax credit if he is eligible for Medicaid, so the marketplace applies the state Medicaid rules first. It determines the family size of each individual in the tax household using Medicaid rules. (If the individual is assessed or determined eligible for Medicaid, he will be transferred to his state’s Medicaid agency.) If the individual is ineligible for Medicaid, then the marketplace will look at his household and eligibility for a premium tax credit using premium tax credit rules.

View all key facts

For updated yearly percentages, please see Reference Guide: Yearly Guidelines and Thresholds. 

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 Q&A explains MAGI and the rules for determining Medicaid and CHIP households under MAGI.

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What is MAGI?

MAGI is a methodology used to determine income for the purposes of Medicaid or CHIP eligibility. It is based on tax definitions of income and household. MAGI rules for determining what income to count when determining Medicaid, CHIP, and premium tax credit eligibility are mostly aligned. The rules determining who is in a household and whose income to count, however, can vary significantly. Also, under MAGI rules, an individual or family’s assets do not count in determining eligibility. (For more information on what income counts under MAGI rules, see Key Facts: Income Definitions for Marketplace and Medicaid Coverage.)

To whom do the MAGI rules apply?

All states must use the MAGI rules regardless of the decision to expand Medicaid. However, MAGI rules apply only to certain categories of Medicaid eligibility. These include parents and caregiver relatives, children, pregnant women, and the adult expansion group. States’ previous rules for determining income and households continue to apply to the elderly, disabled, and children in foster care.

How do Medicaid and premium tax credit household rules differ?

Medicaid and CHIP households are determined based on a person’s family and tax relationships as well as their living arrangements. How people file taxes and who is in their tax unit doesn’t always determine who is in their Medicaid household, but it determines which Medicaid household rules apply in defining the household. Premium tax credit household rules, on the other hand, are based purely on tax relationships.

The most important difference between Medicaid and premium tax credit households is that for Medicaid, household size and composition are determined separately for each member of the household, but for the premium tax credit, members of a tax unit are always treated as a household. This means that for Medicaid, household size may differ for family members even when they are in the same tax filing household. Thus, it is possible that for Medicaid, a family of three filing its taxes together may have two members with a household size of three and the third member of the family may be a household of one. For the premium tax credit, each member of a household that files its taxes together will have the same household size. (For more information on determining household size for the premium tax credit, see Key Facts: Determining Household Size for the Premium Tax Credit.)

Another important difference is Medicaid provides states with several options that affect how they define households when determining Medicaid eligibility. However, because the premium tax credit is a federal benefit, the rules are established at the federal level and are consistent across states.

How does Medicaid determine who is in a household?

Medicaid determines an individual’s household based on their plan to file a tax return, regardless of whether or not he or she actual files a return at the end of the year. Medicaid also does not require people to file a federal income tax return in previous years.

For each individual applying for coverage, Medicaid looks at whether he or she plans to be:

• a tax filer
• a tax dependent
• neither a tax filer nor a dependent

People’s intended tax filing status determines which Medicaid household rules apply in making the household determination. Figure 1 summarizes the Medicaid household rules and Figure 2 shows how to apply these rules. (For more information, see Reference Guide: Medicaid Household Rules.)

FIGURE 1: MAGI Rules for Determining Medicaid and CHIP Households

FIGURE 2: How to Determine An Individual’s Medicaid Household

What are the household rules for a tax filer?

For tax filers claiming their own exemption and who can’t be claimed as a tax dependent, the household includes the tax filer, the spouse filing jointly, and everyone whom the tax filer claims as a tax dependent.

What are the household rules for tax dependents?

For tax dependents, the household is the same as the tax filer claiming the individual as a tax dependent. However, there are three exceptions to this rule, when the rule for non-filers is applied:

• Individuals who expect to be claimed as a dependent by someone other than a parent;
• Individuals (under 19) living with both parents, whose parents do not expect to file a joint tax return; and
• Individuals (under 19) who expect to be claimed as a dependent by a non-custodial parent.

What are the household rules for people who neither file a tax return nor are claimed as a tax dependent?

For individuals who neither file a tax return nor are claimed as a tax dependent, the household rules differ based on whether the individual is an adult or a minor:

• For individuals 19 years and older, the household includes the individual plus, if living with the individual, his or her spouse and children who are under 19 years old.
• For individuals under 19 years old, the household includes the individual, plus any siblings under 19 years old, children of the individual and parents who live with the individual.

Are there any adjustments to the three rules based on people’s tax filing?

In addition to the general rules for determining household size, some rules apply in all situations:

• Married couples who live together are always counted in each other’s household regardless of whether they file a joint or separate return.
• Family size adjustments need to be made if the individual is pregnant. In determining the household of a pregnant woman, she is counted as herself plus the number of children she is expected to deliver.

What are different options that states have for implementing MAGI? 

States have flexibility in how they implement the MAGI rules in two areas. First, in some instances the Medicaid household rules applied may depend on whether an individual is under 19 years old or not. Where the rules indicate an age limit, states have the option to extend that age limit to 21 if the individual is a full-time student. Second, for individuals whose household includes a pregnant woman (but are not pregnant themselves), states can count the pregnant woman as one, two, or one plus the number of children she is expecting.

Are married couples who file taxes separately considered to be in separate households? 

Generally, no. Married couples who live together are always considered to be in each other’s household regardless of how they file taxes.

However, married couples who don’t live together and who file taxes separately will be considered as separate households.

How does Medicaid determine the household size of family members when the parents live together but are not married?

As long as both parents file taxes, non-married parents living in the same household would still use the rule for tax filers to determine each parent’s Medicaid household. This means their household includes themselves and anyone claimed as a dependent on their tax return.

However, a child under 19 living with non-married parents and being claimed as a tax dependent by one of the parents, would fall into the non-filer rule. Therefore, the child’s household size for Medicaid would include himself, both parents, and any siblings living with the child. For example:

• Dan and Jen live together with their two children, Drew and Mary. Because they are not married, Dan and Jen must file separate returns. Jen claims Drew and Mary as tax dependents on her tax return. Dan files as a single person and doesn’t claim any tax dependents. Table 1 illustrates the household size determination for each member of the family. To determine the household size for Dan and Jen, Medicaid would apply the tax filer rule and include everyone in each of their specific tax household. To determine the household size for Drew and Mary, Medicaid would apply the non-filer rule because they are children living with both parents who are not expected to file a joint return.

How does Medicaid determine the household of an adult child who is claimed as a tax dependent by his parents? 

The household of an individual who is at least 19 years old and is claimed as a tax dependent by his parents is always the same as the household of the parents claiming him. This is true even if the individual was much older, say 35 years old. For example, under some circumstances parents can claim their child who is 35 years old as a qualifying relative on their tax return. In this scenario, Medicaid would use the tax dependent rule for determining the household of this individual, which means his household would be the same as the household of his parent (the tax filer) claiming him as a dependent. The following examples illustrate how the Medicaid rules would be applied:

• Barry is 29 and is claimed as a tax dependent by his parents. His parents also claim Barry’s younger brother and sister, who are 15 and 17. When determining his household for Medicaid, Barry has the same household as the tax filer claiming him as a dependent, thus Barry would have a household size of five: himself, both of his parents, and his brother and sister.
• Carla is 28 years and lives with both parents who are married. However, her parents file separate tax returns and Carla’s father claims her as a dependent on his tax return. Even though Carla’s parents file separate returns, married people living together are always in the same household as their spouse. As a result, Carla’s father has a household of three: himself, his spouse, and Carla. This means that Carla also has a household of three.

Does the exception to the tax dependent rule for tax dependents who are not a child of the taxpayer only apply to adult tax dependents? 

No. This exception also applies to minors claimed as a tax dependent by someone other than their parent. Anytime an individual — regardless of age — is claimed as a tax dependent by someone other than their parents, the non-filer rules apply in determining that individual’s household. For example:

• Leena lives with and is under the guardianship of her aunt. She is five years old and doesn’t have any siblings or parents living with her. Leena’s aunt claims her as a qualifying relative on her tax return. Leena is a tax dependent but she falls under one of the exceptions to the tax dependent rule because she is not the tax dependent of her parents. This means Medicaid will use the non-filer rules to determine her household, and as a result, Leena’s household consists only of herself.

View all key facts

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.

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How do marketplaces, Medicaid, and CHIP measure a person’s income?

For the premium tax credit, most categories of Medicaid eligibility, and CHIP, all marketplaces and state Medicaid and CHIP agencies determine a household’s income using MAGI. States’ previous rules for counting income continue to apply to people who qualify for Medicaid based on age or disability or because they are children in foster care.

MAGI is adjusted gross income (AGI) plus tax-exempt interest, Social Security benefits not included in gross income, and excluded foreign income. Each of these items has a specific tax definition; in most cases they can be located on an individual’s tax return (see Figure 1). (In addition, Medicaid does not count certain Native American and Alaska Native income in MAGI.)

FIGURE 1: Formula for Calculating Modified Adjusted Gross Income

What is adjusted gross income?

Adjusted gross income is the difference between an individual’s gross income (that is, income from any source that is not exempt from tax) and deductions for certain expenses. These deductions are referred to as “adjustments to income” or “above the line” deductions. Common deductions include certain contributions to an individual retirement account (IRA) or health savings account (HSA) and payment of student loan interest. Many income adjustments are capped or phased out based on income. IRS Publication 17 explains adjustments to income in more detail.

What types of income count towards MAGI?

All income is taxable unless it’s specifically exempted by law. Income does not only refer to cash wages. It can come in the form of money, property, or services that a person receives.

Table 1 provides examples of taxable and non-taxable income. IRS Publication 525 has a detailed discussion of many kinds of income and explains whether they are subject to taxation.

Is income subtracted from workers’ paychecks as a pre-tax deduction counted in MAGI?

No. Pre-tax deductions — such as health insurance premiums, retirement plan contributions, or flexible spending accounts — are taken out of wages by the employer. Since this income isn’t taxed, it doesn’t count towards a household’s MAGI. The wages in Box 1 of Form W-2 already exclude any pre-tax benefits so they don’t appear on the tax return as income or deductions.

Does MAGI count any income sources that are not taxed?

Yes. Some forms of income that are non-taxable or only partially taxable are included in MAGI and affect financial eligibility for premium tax credits and Medicaid. Specifically:

• Tax-exempt interest. Interest on certain types of investments is not subject to federal income tax but is included in MAGI. These investments include many state and municipal bonds, as well as exempt-interest dividends from mutual fund distributions.
• Non-taxable Social Security benefits. . For many people, particularly those with no other source of income, Social Security benefits are not taxed at all. However, if there is other income, a portion of the benefit might be taxed. Social Security benefits are reported on Form SSA-1099 (the Social Security Benefit Statement) and, whether or not those benefits are taxable, the full amount is included in MAGI.
• Foreign income. Under section 911 of the Internal Revenue Code, U.S. citizens and resident aliens living outside the U.S. can exclude some earned income for tax purposes if they meet certain residency or physical presence tests. Any foreign income excluded under this section must be added back when calculating MAGI.

Whose income is included in household income?

Household income is the MAGI of the tax filer and spouse, plus the MAGI of any dependent who is required to file a tax return. A dependent’s income is only included if they are required to file taxes; if they file taxes for another reason but had no legal filing requirement, their income is not included.

Is a tax dependent’s income ever included in household income?

If a dependent has a tax filing requirement, his or her MAGI is included in household income. Under rules put in place by the December 2017 tax law, a dependent must file a tax return for 2020 if she received at least $12,400 in earned income; $1,100 in unearned income; or if the earned and unearned income together totals more than the greater of $1,100 or earned income (up to $12,050) plus $350. In general, unearned income is defined as investment income; Supplemental Security Income (SSI) and Social Security benefits are not counted in determining whether a dependent has a tax-filing requirement. However, if the dependent does have a tax filing requirement, the dependent’s Social Security benefits will be counted toward the household’s MAGI.

If a dependent does not have a filing requirement but files anyway — for example, to get a refund of taxes withheld from their paycheck — the dependent’s income would not be included in household income.

What time frame is used to determine household income?

Financial eligibility for the premium tax credit and Medicaid is based on income for a specified “budget period.” For the premium tax credit, the budget period is the calendar year during which the advance premium tax credit is received. When determining eligibility for an advance premium tax credit, the applicant projects their household income for the entire calendar year.

Medicaid eligibility, however, is usually based on current monthly income. But for people with income that varies over the year, states must consider yearly income if the person wouldn’t be eligible based on monthly income. For example, a seasonal worker might be over the income limit based on monthly income if they are employed when they apply but would be under the limit if their yearly income (including the months where they are unemployed) is considered. The Medicaid agency must determine eligibility using the yearly income. This prevents situations where people are considered ineligible for the Marketplace based on their yearly income and ineligible for Medicaid based on their monthly income. In addition, Medicaid also treats some lump-sum income differently than the marketplace, by considering it only in the month received.

How does MAGI differ from Medicaid’s former rules for counting household income?

The MAGI methodology for calculating income differs significantly from previous Medicaid rules. Some income that Medicaid used to consider part of household income is no longer counted, such as child support received, veterans’ benefits, workers’ compensation, gifts and inheritances, and Temporary Assistance for Needy Families (TANF) and SSI payments. Table 2 summarizes the differences between the former Medicaid rules and the new MAGI rules.

In addition, states can no longer impose asset or resource limits, and various income disregards have been replaced by a standard disregard equal to 5 percent of the poverty line. There are also changes to who is included in a household and, therefore, whose income is counted.

View all key facts

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

In this Health Reform: Beyond the Basics webinar presented on October 1, 2019, Tara Straw, Senior Policy Analyst, and Shelby Gonzales, Director of Immigration Policy, detail the rules used to determine household size and explain what counts as income when determining eligibility for the premium tax credit and Medicaid.

↓ View Presentation Slides (PDF)

Watch the Webinar

Additional Resources

Reference Guide: Medicaid Household Rules

Reference Guide: Yearly Guidelines and Thresholds

Guide: Health Assister’s Guide to Tax Rules

Key Facts:

• Determining Households for Medicaid and CHIP
• Determining Households for PTC
• Income Definitions for Marketplace and Medicaid Coverage

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

Tools and Resources | View all tools and resources

Frequently Asked Questions | View FAQs

In this Health Reform: Beyond the Basics webinar presented on September 18, 2018, Tara Straw, Senior Policy Analyst, and Shelby Gonzales, Senior Policy Analyst, detail the rules used to determine household size and explain what counts as income when determining eligibility for the premium tax credit and Medicaid.

This is Part II is a four-part series on core elements of eligibility and enrollment.

Presentation Slides

↓ View presentation slides (PDF) 

Watch the Webinar

Why Household Size Matters

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Calculating percent of federal poverty line (FPL)

• Effect on expected premium contribution

Why Tax Filing Status Matters

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Overview of tax filing statuses

Marital status and the premium tax credit

• Exceptions to the joint filing rule

Determining Households for the Premium Tax Credit

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Households for the PTC

• Determining tax dependents (video section, slides)
• Examples: Who can be claimed as a tax dependent?

Determining Households for MAGI Medicaid

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Rules to determine households for Medicaid using MAGI rules

Examples: (video section, slides)

• Married couple with children
• Three-generation household
• Non-married parents

What Counts as Income for PTCs and Medicaid

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Definition of modified adjusted gross income (MAGI)

General rules about counting income

• Tips when dealing with self-employment income
• 2017 tax law changes
• When to count a dependent’s income

How Marketplaces and Medicaid Combine Household and Income Rules to Determine Eligibility

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Example: Three-generation household

Example: Non-married parents

Q&A

Additional Resources

Resources | View resources links

Reference Guide: Medicaid Household Rules

Reference Guide: Yearly Guidelines and Thresholds

Guide: Health Assister’s Guide to Tax Rules

Key Facts:

• Determining Households for Medicaid and CHIP
• Determining Households for PTC
• Income Definitions for Marketplace and Medicaid Coverage

Webinar OE6: Premium Tax Credits

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

Tools and Resources | View all tools and resources

Frequently Asked Questions | View FAQs

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