If you believe you are still eligible, a possible reason may be that you did not file a tax return with the Internal Revenue Service (IRS) or did not include information about your prior year insurance subsidy in your tax filing for that year. You can find past due tax forms on the IRS website.
If this was not the case and you believe you should be eligible, call your state marketplace, or if you use HealthCare.gov go to your account and confirm that you did file your taxes and include the appropriate forms. How quickly you act will impact how soon your tax credits can be restored.
The level of financial assistance available to you is determined by the size of your family and your annual income. The Affordable Care Act (or ACA) uses what’s called your modified adjusted gross income (MAGI) to determine how much financial assistance you can receive, generally in the form of a tax credit.
When you apply for financial assistance through the marketplace, the application will walk you through the information you need to calculate your income. If you still need help, contact the Marketplace Call Center.
Keep in mind that if you estimate your income incorrectly and end up receiving more help than you are eligible for, you may have to pay back some or the entire subsidy that you received when you pay your taxes next year. If you over estimate your income and end up receiving less help than you are entitled to, the difference will be refunded to you when you file your income taxes.
When you file your federal taxes, you will need to fill out and attach a form known as Form 8962 [PDF] .
In January, you should receive Form 1095-A in the mail from your health insurance marketplace. This form is specific to you and will indicate the amount of insurance subsidy you received last year. If you didn’t receive Form 1095-A, you should call your state marketplace; or if you live in a federal marketplace state, you can log into your account on HealthCare.gov and find it there.
You will use this form to fill out Form 8962, which you can download here. Form 1095-A will tell you whether you are required to repay any portion of your insurance subsidy or whether you are owed any money back back and will provide the information you need to fill out Form 8962 (which you need to submit with your tax return). This is determined by the actual amount of income you earned in the year you received your subsidy.
After you have filed your taxes, you will need to 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.
If you need help filing your tax return, the Internal Revenue Service (IRS) lists programs offering free tax assistance here.
The Federal Poverty Level (FPL) is an estimate of the income an individual needs to meet his or her food, housing, medical care and other basic living expenses. It is adjusted every year. There is one level for the 48 continental states and separate levels for Alaska and Hawaii, reflecting higher living costs there. The poverty level is also adjusted for the number of members in a family.
Many federal programs have income eligibility rules based on a specific percentage of the poverty level. For insurance coverage provided through the Affordable Care Act (or ACA), financial assistance is available in the marketplaces for persons without other coverage and incomes between 100 percent ($12,060 a year for a single person) and 400 percent of the federal poverty level (about $48,240 a year for a single person).
In states that have expanded Medicaid, people are eligible if their income is below 138 percent of the poverty level, about $16,643 a year or less for a single person (or $22,411 or less as a couple).
I am not required to file a tax return based on my income level. If I received an insurance subsidy do I need to?
Yes. Under federal rules, anyone who receives a subsidy to offset the costs of their insurance must file a tax return, regardless of income, along with a special tax form – Form 8962 [PDF]. This is to confirm your eligibility for and receipt of the correct amount of financial assistance based on your actual household income for that year.
I received an insurance subsidy last year, but did not file a tax return or did not include information about my subsidy in my return. What should I do?
Once you have done this, log into your marketplace account and check the “yes” box for the question asking if you have reconciled your tax credits.
The Affordable Care Act (ACA) makes tax credits available for lower-income people to help them afford health insurance. The tax credit lowers the premium paid for health insurance by a person or family. In some cases, financial help is also available for cost sharing.
Not everybody who is eligible to purchase coverage in the marketplace will be eligible for subsidies, however. To qualify for subsidies you will have to meet additional income and eligibility requirements. To find out if you qualify for a subsidy, use the Kaiser Family Foundation subsidy calculator.