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Tag: marketplace

I’m low income and enrolled in subsidized Marketplace coverage now. I just found out I’m pregnant. Under my state’s rules, I now qualify for Medicaid. Do I have to drop out of the Marketplace coverage and enroll in Medicaid? If I don’t will I have to pay back the premium tax credit subsidy?

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.

I’m under 26 and eligible to be covered as a dependent under my mom’s job-based policy. Mom no longer claims me as a tax dependent – I file my own taxes, though my income isn’t very high. If subsidized Marketplace coverage would be even more affordable to me can I sign up for that instead?

Yes. Although the general rule is that people are not eligible for Marketplace subsidies when they are also eligible for affordable job-based health coverage, there is a special rule for young adults. As long as a young adult is not claimed as a tax dependent by her parents, the availability of dependent coverage under her parents’ health plan does not affect her eligibility for premium tax credits in the Marketplace.

If I’ve not filed taxes in a prior year, how will the Marketplace determine my income?

If an applicant did not file taxes in a prior year, income will be verified by the Marketplace through use of electronic wage data. If the information cannot be verified electronically, the applicant may be asked to submit additional paper documentation within 90 days, such as pay stubs, a work contract or other verification of income.

I got health insurance last year through a Marketplace plan and also received advanced premium tax credits to reduce my monthly premium. What happens if I don’t file my federal income tax return this spring? What if I file but don’t include Form 8962?

For any year when you received advanced premium tax credits, you are required to file a federal income tax return, including Form 8962.  If you fail to do this — it is called “failure to reconcile” — you may be unable to apply for premium tax credits for the following year.  If you file a federal income tax return but don’t include Form 8962, that is also considered a failure to reconcile and you may be prevented from applying for premium tax credits at the next Open Enrollment.
If this happens to you, be sure to remedy this failure as soon as you can.  You can still sign up for health insurance coverage for the coming year, but you won’t be able to get advance premium tax credits until you have filed your prior-year tax return with Form 8962.

I got a premium tax credit in 2017, but I usually don’t file a tax return and didn’t realize I was supposed to file a 2017 return this year. Now I’m trying to renew my premium tax credit for next year and the Marketplace says I can’t. What do I do now?

You should file your federal income tax return for 2017 as soon as possible.  Then log into your Marketplace account, update your application information, and tell the Marketplace that you have filed your taxes by attesting to that question on the application.  Keep in mind that the Marketplace will check with the IRS during the coverage year to verify your return was filed and, if it cannot verify, will terminate your premium tax credit.

I’m raising my grandchild and claim her as a dependent. If I apply for Marketplace subsidies, will we be considered a household of two?

Yes, you will be considered as a household of two for both Medicaid and premium tax credits. However, your grandchild will be considered as her own household for Medicaid and CHIP and your income will not count in determining her eligibility for these programs. Assuming she does not have her own income she will likely be eligible for Medicaid or CHIP and not eligible for premium tax credits for coverage in the Marketplace. You could of course purchase coverage for her in the Marketplace but you would not be eligible for a premium tax credit to help pay for her plan.  Whether you could include her on your policy would depend on what insurers offer in your Marketplace.

I’m enrolled in COBRA now but I want to drop it. Does that affect my eligibility for Marketplace subsidies?

No, having COBRA doesn’t affect your eligibility for premium tax credits. However, you can only drop COBRA and sign up for a Marketplace plan and premium tax credits during Open Enrollment. You will have to drop your COBRA coverage effective on the date your new Marketplace plan coverage begins. After Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity and will have to wait until the next Open Enrollment period.