Navigator Guide FAQ of the Week: Eligibility for Premium Tax Credits

The midterm elections may be over, but open enrollment for the Affordable Care Act marketplaces are in full swing, and CHIR is here to help. We’ve released our updated and improved Navigator Resource Guide, chock full with answers to over 300 frequently asked questions (FAQs) about marketplace eligibility, enrollment, and coverage.

Although the marketplaces have been up and running for five years, many people are still unaware that they may qualify for premium and cost-sharing subsidies. Therefore, as our first FAQ of the Week, we’re highlighting who is eligible for financial help:

QUESTION:

Who is eligible for marketplace premium tax credits?

ANSWER:

Premium tax credits are available to U.S. citizens and lawfully present immigrants who purchase coverage in the marketplace and who have income between 100 percent and 400 percent of the federal poverty level. Premium tax credits are also available to lawfully residing immigrants with incomes below 100 percent of the poverty line who are not eligible for Medicaid because of their immigration status. (Generally, immigrants must lawfully reside in the U.S. for five years before they can become eligible for Medicaid.)

In addition, to be eligible for the premium tax credits, individuals must not be eligible for public coverage—including most Medicaid, most Children’s Health Insurance Program coverage, Medicare, or military coverage—and must not have access to affordable, adequate health insurance through an employer. There are exceptions to when you can apply for premium tax credits when you have other coverage. For example, there is an exception in cases when the employer plan is unaffordable because the employee’s share of the premium exceeds 9.86 percent of the employee’s household income in 2019 (for 2018, it was 9.56 percent). There is also an exception in cases where the employer plan doesn’t provide a minimum value or actuarial value (the plan’s share must be at least 60 percent of the cost of covered benefits for a standard population). (26 C.F.R. § 1.36B-2; IRS, Rev. Proc. 2018-34).

For answers to this and hundreds of questions on marketplace eligibility, financial help, coverage options, and more, visit the Navigator Resource Guide here.

Leave a Reply

Your email address will not be published. Required fields are marked *