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)

This webinar, presented on December 18, 2019,  explains how to reconcile the premium tax credit, which provides significant financial assistance to low- and moderate-income families who purchased coverage in the marketplace. This is an advance ACA certification topic for VITA and TCE volunteers.

This webinar is designed to help VITA/TCE sites and other volunteer tax preparers understand the ACA components of a tax return in order to assist low-income tax clients for the 2019 tax season.

Presentation Slides

↓ View presentation slides (PDF)

↓ Download PowerPoint presentation slides (PPT)

Watch the Webinar

Additional Resources

Premium Tax Credits Tips and Tricks (TY2019) | View resource

Resources for Volunteer Tax Preparers | View resources

As part of the ACA tax training webinar series for VITA/TCE volunteers presented on November 13, 2018, this webinar explains how to reconcile the premium tax credit, which provides significant financial assistance to low- and moderate-income families who purchased coverage in the marketplace. This is an advance ACA certification topic for VITA and TCE volunteers.

This webinar series is designed to help VITA/TCE sites and other volunteer tax preparers understand the ACA components of a tax return in order to assist low-income tax clients for the 2018 tax season.

Presentation Slides

↓ View presentation slides (PDF)

↓ Download PowerPoint presentation slides (PPT)

Watch the Webinar

Overview of What’s Covered

Premium Tax Credit Rules and TaxSlayer

Jump to video section, View slides  

• Eligibility criteria for PTC
• Form 8962: Reconciling the PTC
• Form 1095-A
• Repayment of APTC
• Income below 100% FPL
• Entering Form 1095-A in TaxSlayer

Complex Form 1095-A Issues

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Issue:

• I thought I would file jointly, but I’m Married Filing Separately
• Multiple Forms 1095-A
• Failure to pay premiums
• Only Column A of Form 1095-A is completed
• Overlapping coverage

Review Tips

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• Preview the return
• Form 8962 review
• If there is a repayment of APTC
• Failure to reconcile

Q&A

Additional Resources

VITA/TCE Basic Certification: Exemptions and the Individual Mandate | View webinar

Premium Tax Credits Tips and Tricks (TY2017) | View resource

Resources for Volunteer Tax Preparers | View resources

↓ Read the final rule

↓ Read the guidance on hardship exemptions 

For an overview of the rule changes, see our paper, “Health Care Rule Changes Will Harm Consumers,” detailing how these changes will weaken benefit standards, likely harming people with pre-existing conditions; raising new barriers for people who want to enroll in health coverage; and reducing accountability for insurers and transparency for consumers.

Changes from the final rule and additional guidance include:

Altered rules for navigator programs.  Under the rule, marketplaces are permitted to have just one navigator entity serve the entire state. In addition, the rule allows navigators to not have a physical presence in the state they are paid to serve and no longer requires that one navigator group in a service area be a consumer-focused nonprofit organization.

New requirements for verification of income.  The rule requires individuals to verify their income if their attested income is above the poverty line but data sources suggest that income is below the poverty line. This will make it harder for eligible individuals with fluctuating poverty-level income to access much-needed financial help to afford coverage.

Expanded hardship exemption.  Effective immediately, new guidance expands the situations in which people can receive a hardship exemption to include people who:

• Show that a lack of choice when there is only one issuer in their area “precluded” them from obtaining coverage;
• Cannot buy an affordable plan that does not include abortion coverage, which is contrary to the individual’s beliefs;
• Have no qualified health plan in their area (a circumstance no marketplaces have ever experienced); or
• Experience personal circumstances that may qualify as a hardship, such as when available QHPs don’t cover needed specialty care.

New special enrollment period (SEP) for loss of pregnancy-related coverage provided through CHIP.  The rule adds an additional SEP for the loss of coverage provided through the Children’s Health Insurance Program (CHIP) “unborn child” option, which only covers pregnancy-related services and is not considered minimum essential coverage. This SEP will go into effect on June 18, 2018.

Removes requirement to provide adequate notice to those who fail to reconcile APTC.  People who receive APTC are required to file a tax return and reconcile the tax credit, or they risk losing financial assistance when they re-enroll. Current rules require that the Marketplace must first provide enrollees with information about failure to reconcile, giving them a chance to correct the record if they in fact reconciled or remedy the situation by filing a tax return, but the new rule removes that requirement to first send notice directly to the tax filer before discontinuing APTC.

Allows states and insurers to scale back benefits.  Beginning in 2020, the new rule changes the standards for how states create a benchmark plan to establish the minimum standard for the ten essential health benefits offered in that state and how insurers comply with them, opening up new ways for states and insurers to scale back coverage of services that are costly but critical to people with serious health needs.

There are additional changes in the rule including weakening the risk adjustment program by letting states shrink risk adjustment transfers by up to 50%, reduced transparency of insurance premium rates, and diminished standards for the “medical-loss ratio” requiring insurers to spend at least 80% of what they collect in premiums on medical care and improving healthcare quality. For more detailed information on the harmful changes in this rule, please see our paper, “Health Care Rule Changes Will Harm Consumers.”

Updated February 2018

This tool, Premium Tax Credits Tips and Tricks, explains Form 1095-A and how it’s used to reconcile the premium tax credit on Form 8962. It also shares a few tips and tricks to help resolve complex premium tax credit questions.

This resource was incorporated into IRS Publication 4012. For more information, please see IRS Publication 4012, Tab ACA: Affordable Care Act.