OE9 Webinar: Part I Households & Income

Determining Households and Income for Premium Tax Credits and Medicaid

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.

View Presentation Slides (PDF)

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