No. Unlike premium tax credits, which are reconciled each year based on the income you actually earned, cost-sharing reductions are not reconciled.
That depends on your income and where you live. To give a general idea, a typical Silver plan might have an annual deductible of $4,000, for example, and an annual out of pocket limit on all cost sharing of $7,900. But if your income is between 100% and 150% of the federal poverty level, the cost-sharing reductions will modify a Silver plan so that the annual deductible might be closer to $250 and the annual out-of-pocket limit on all cost sharing would be no more than $2,600.
If your income is between 150% and 200% of the federal poverty level, the cost-sharing reductions will modify the Silver plan so that the annual deductible might be around $800 and the annual out-of-pocket limit would be no more than $2,600.
If your income is between 200% and 250% of the federal poverty level, the cost-sharing reductions will be more modest. At this income level, your annual out-of-pocket limit will be reduced to no more than $6,300.
Check the Marketplace website for more information about cost sharing reductions in Silver plans in your area based on your level of income.
No, you can only get cost-sharing reductions by enrolling in a Silver Marketplace plan. You will not receive cost-sharing reductions if you enroll in a Bronze, Gold, or Platinum plan. Note that this is different from the rule for premium tax credits. You can apply premium tax credits to all four types of plan. However, if you are eligible for both kinds of help (that is, if your income is between 100% and 250% of the federal poverty level), you can only receive both types of subsidies if you enroll in a Silver plan.
No. Cost-sharing subsidies did not end. They continue to be available in the Marketplace. By law, insurers offering coverage on the Marketplace are still required to offer cost-sharing reductions to consumers with income between 100% and 250% of the poverty level.
Yes. If your income is between 100% and 250% of the federal poverty level, you can also qualify for cost-sharing reductions. These will reduce the deductibles, copays, and other cost sharing that would otherwise apply to covered services.
The cost-sharing reductions will be available through modified versions of Silver plans that are offered on the Marketplace. These plans will have lower deductibles, copays, coinsurance and out-of-pocket limits compared to regular Silver plans. Once the Marketplace determines you are eligible for cost sharing reductions, you will be able to select one of these modified Silver plans, based on your income level.
Yes. If you are married but unable to file a joint return because of domestic abuse, you can file as married-filing-separately and claim the premium tax credit. Similarly, if you cannot file a join return because you are unable to locate your spouse due to spousal abandonment, you can file as married-filing-separately and claim the premium tax credit. In either instance, you will need to check the “Relief” box in the top right-hand corner of Form 8962 and file that with your tax return. You are not required to submit documentation of the abuse or abandonment with your tax return, but should keep any documentation for your records.
Generally no. Married taxpayers are required to file a joint tax return in order to qualify for premium tax credits. People who use the “married filing separately” status are not eligible to receive premium tax credits (and also cannot claim certain other tax breaks, such as the child and dependent care tax credit, tuition deductions, or the earned income tax credit.) There is a special exception, however, for individuals who must file separately because of domestic abuse or spousal abandonment.
For other married individuals who do not file a joint return, there may be other options.
If you have a dependent and meet certain conditions, you may be able to use the “head of household” filing status. People who file a tax return using this filing status can qualify for premium tax credits.
In addition, if you expect to be divorced by the end of the tax year, you will be able to file as a single taxpayer for that year and could qualify for subsidies under that filing status when you file your taxes. However, you may not be able to receive all of the premium tax credit that you’re entitled to in advance if you are not yet divorced with you make your Marketplace application. Except in cases of domestic abuse or spousal abandonment you should not say on your application that you are unmarried when you are still married.
Check with your tax adviser or a health insurance Marketplace Navigator for more information.
In nearly all states, pregnancy-related Medicaid provides the same (or similar) benefits as Medicaid for other adults and so is considered minimum essential coverage (MEC). (In 3 states – Arkansas, Idaho, and South Dakota – pregnancy-related Medicaid only covers maternity care and is not recognized as MEC). The general rule requires that people eligible for other MEC are not eligible for premium tax credits. However, a special rule allows women who are already receiving APTC and who become pregnant and eligible for pregnancy-related Medicaid to choose whether to stay in their marketplace plan with APTC or enroll in the pregnancy-related Medicaid. For example, women might choose pregnancy-related Medicaid because it does not charge monthly premiums or cost sharing for covered services.
If you decide to enroll in the pregnancy-related Medicaid (in all but 3 states), you will no longer be eligible for APTC while you are enrolled in Medicaid. If you decide to enroll in the pregnancy-related Medicaid and live in one of 3 states offering limited benefits, you can apply for an exemption from the individual mandate and won’t owe a penalty for lacking MEC coverage during those months. In all states, when your pregnancy and pregnancy-related Medicaid ends, you will be eligible for a special enrollment period (SEP) and can sign up for marketplace coverage and APTC at that time.
But if you prefer to stay in your marketplace plan you can continue receiving APTC and won’t be required to pay it back later just because you were eligible for pregnancy-related Medicaid.
If you all enroll in the same plan, you would only be eligible for a plan with a 73 percent actuarial value; that is the lowest-value plan for which all of you would qualify in this situation.
You can all enroll in the same family plan, and your daughter can apply her premium tax credit to reduce her share of the premium for that family plan, but your daughter would lose her eligibility for cost-sharing reductions. If two individuals (or two separate households) qualify for different levels of cost-sharing assistance, or if one qualifies and the other doesn’t, and if they want to be covered under the same plan, they must select a plan that provides the level of cost-sharing reduction that they all would qualify for. In this case, since you do not qualify for any help with cost sharing, the three of you could only enroll together in a plan without cost sharing subsidies.