Tuesday, September 12, 2017, 09:10

If you are signing up for Health Insurance through the Marketplace, you may want to keep the following in mind in determining whether you qualify for a Premium Tax Credit subsidy.

Note: Even if you’ll be automatically enrolled, it’s really important to log into your 2019 application and make any changes to your income, household information, or insurance status that have happened since you filled out your 2018 Marketplace application – or that you expect in 2019. You may have new options for 2019 that save you money, provide more coverage, or give you access to more doctors. By updating your information you’ll be sure to get the right options and savings for 2019. Open enrollment ends December 15, 2018.  Coverage will begin as of January 1, 2019.

Per the healthcare.gov website, all 2018 Marketplace coverage ends as of December 31, 2018, no matter when it started. Beginning in 2019, individuals without health insurance will not have to pay the penalty that was mandated under The Patient Protection and Affordable Care Act, often referred to as Obamacare.  This penalty is, however, still in place for 2018 and will be reflected on the 2018 individual income tax return. 

Taxpayers within certain ranges of income may qualify for subsidies to make their insurance coverage more affordable. If you are not already covered by a plan or are looking for a more affordable plan or just have questions about the Individual Mandate under the Affordable Care Act, you can use the following links to compare prices on qualified health plans and sign up for a plan that meets your needs and meets the minimum essential coverage required under the Patient Protection and Affordable Care Act.

For those 65 and older - If you will soon be 65 and older, you may use this site to find information on signing up for Medicare.

For those under age 65 -  Use this link to healthcare.gov to find out if you MAY qualify for a subsidy or premium tax credit based upon your household income and number of exemptions you will be eligible to claim on your 2019 tax return.

Note that if you are eligible to be covered under an employer-sponsored plan, you generally will not qualify for the subsidy or premium tax credit if the portion of the annual premium you must pay for self-only coverage does not exceed 9.56 percent of your household income. Be sure that you pay special attention to the answers to questions 6, 7, 8, and 11 on this IRS Question and Answer page on the Premium Tax Credit. If you receive a subsidy during the year, but do not qualify for the Premium Tax Credit, you will have to repay the subsidy.

Also, pay special attention to the income you need to include in computing household income (Question 8). This is from the IRS's page: "For purposes of the premium tax credit, your household income is your modified adjusted gross income plus that of every other individual in your family for whom you can properly claim a personal exemption deduction and who is required to file a federal income tax return. Modified adjusted gross income is the adjusted gross income on your federal income tax return plus any excluded foreign income, nontaxable Social Security benefits (including tier 1 railroad retirement benefits), and tax-exempt interest received or accrued during the taxable year. It does not include Supplemental Security Income (SSI)."

To accurately determine if you qualify for a subsidy or premium tax credit, you need to answer the questions as truthfully as possible when applying for health insurance. This is the case whether you apply for coverage online through the healthcare.gov website, through the DrakeHealth website, or by consulting an insurance representative.


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