No. If you were determined eligible for subsidies when you signed up, and your income turns out to be lower, you will not have to repay the subsidies you received.
The adjustment will take effect by the first day of the month following the date of the redetermination notice. For example, if an enrollee reports a change in income on June 25 and the Marketplace verifies the change and sends a redetermination notice to the enrollee on July 3, the change will be implemented on August 1.
Yes, you can make adjustments during the year whenever you need to. There is no limit to the number of times a person may report income, family or insurance-eligibility changes to the Marketplace. Changes that are reported by enrollees will be verified by the Marketplace. Then the Marketplace will send you a notice (called a redetermination notice) showing your revised eligibility for premium tax credits and cost-sharing reductions. In addition, people can always ask the Marketplace to provide them with a monthly advance premium credit below the amount the Marketplace determines based on the household’s income if they want to minimize the chance of owing money at the end of the year.
It’s common for income to fluctuate, particularly if you are self-employed, perform seasonal work or have multiple jobs. To achieve the most accurate premium tax credit amount, you should report income changes to the health insurance Marketplace during the year, as they happen. Otherwise, if you claim a premium tax credit during the year and your actual income for the entire year edges over 400% FPL, you will need to pay back the full credit amount. To avoid this result, if you estimate your annual income will be close to 400% FPL, you could also consider waiting until you file your taxes to take all or a portion of the premium tax credit on your tax return instead of receiving advance payments.
Unfortunately, in most states so far, the data match inconsistency notices are not very specific in describing the additional documentation that is required. Instead, notices list generic types of types of income documentation without specifying the documentation appropriate for you. If you are self-employed and estimate your income next year will be significantly less than what you reported on your most recent tax return, you should provide copies of any documents that support your estimate. Make sure to provide copies and not original documents. If you don’t have documents, a signed statement explaining your estimate may be accepted. Be sure to include your name and ID number, a description of the income you expect to earn next year, a description of how you arrived at your estimated income amount, and an explanation of why other documentation is not available.
In reviewing your application, the Marketplace will compare the amount of income you estimate for next year to the most recent information about your income that is available (usually, that will be the tax return you filed this year reporting last year’s income.) Generally, if that amount differs from the amount you put on your application by more than 25% or $6,000 (whichever is greater), you might receive a data match inconsistency notice from the Marketplace and you’ll need to provide more documentation.
In cases of an income data match inconsistency, the Marketplace will ask you to provide documentation within 90 days. During that period, you can get premium tax credits based on the income you attested to in your application. However, if you have not resolved the data match inconsistency within 90 days, the Marketplace will adjust or end your advance premium tax credit based on the most recent income information it can find.
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.