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I can’t afford to pay much for deductibles and co-pays. Is there help for me in the Marketplace for cost sharing?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

I am still legally married, but live apart from my spouse because of domestic abuse or abandonment. I cannot file a joint tax return. Can I qualify for premium tax credits if I file as married-filing-separately and don’t take into account my spouse’s income?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

I am married but my spouse and I live apart and we do not file a joint tax return. Instead, I use the “married filing separately” tax filing status. I have low income and need help paying health insurance premiums. Can I qualify for premium tax credits?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

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?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

My 24-year-old son, who is working, lives near me and my spouse. My spouse and I are eligible for a silver plan with a 73 percent actuarial value, but my son is eligible for a plan with an 87 percent actuarial value. What happens if we all enroll in one family policy?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

My 24-year-old daughter, who is working, lives near me and my spouse. We do not claim her as a tax dependent. She is eligible for premium tax credits and a cost-sharing reduction. We are not eligible for any subsidies, but we would all like to enroll in the same plan. Can we do that?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

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?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

My partner and I live together but are unmarried. Is our combined household income what we should report?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

Because you are not married, you will be considered two separate households for the purposes of determining eligibility for premium tax credits and Medicaid. Assuming that neither of you are claiming any dependents on your tax returns, you will each be considered as a household of one and your own income will be used to determine eligibility for premium tax credits and Medicaid as well as the amount of any premium tax credit and cost-sharing reduction you may qualify for. If you are eligible for premium tax credits, you will each receive a separate determination of the amount of your credit and whether you are eligible for a cost-sharing reduction. Whether you can use your credits to buy a family policy rather than two individual policies will depend on the offerings in your state Marketplace.

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

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.