Eligibility for Tax Credits
Eligibility for the premium tax credit is based on the household income and access to minimum essential coverage. The following summarizes the key eligibility standards for premium tax credits (tax credits that reduce the cost of insurance premiums).
Individuals must meet the following eligibility criteria to be eligible for a premium tax credit:
- Not be eligible for minimum essential coverage — including employer-sponsored coverage, Medicaid, CHIP, Medicare, and other forms of coverage — other than through the individual insurance market, unless their employer-sponsored coverage is not affordable or does not provide minimum value
- Have an annual household income that is between 100% and 400% of the Federal Poverty Level (FPL) (or below 100% of FPL for lawfully present non-citizens who are ineligible for Medicaid by reason of immigration status)
- Be a part of a tax household that will file a tax return for the coverage year and, if the tax household includes a married couple, that files a joint return
- Be eligible for coverage through a QHP
Overview of Eligibility
Some individuals who are eligible to enroll in a QHP will be eligible for financial support to make their health insurance coverage more affordable. As part of the application process, the Marketplace will assess eligibility for premium tax credits and cost-sharing reductions based on household income relative to the Federal Poverty Level (FPL). The 2013 FPL is $11,490 for an individual and $23,550 for a family of four.
Advance Payment of the Premium Tax Credit
Eligibility criteria for advance payment of the premium tax credit are the following:
- Meets the eligibility criteria for enrollment in a QHP (and ultimately enrolls in a QHP offered through the Marketplace)
- Has an annual household income between 100% and 400% of the FPL (or lower if a lawfully present non-citizen who is ineligible for Medicaid by reason of immigration status)
- Be a part of a tax household that will file a tax return and, if the tax household includes a married couple, that will file a joint return
- Is not eligible for minimum essential coverage (including employer-sponsored coverage, Medicaid, CHIP, Medicare, and other forms of coverage), other than through the Individual Marketplace, unless their employer-sponsored coverage is unaffordable or does not provide minimum value
Advance payment of the premium tax credit are not available for the purchase of catastrophic coverage.
Next Topic: Calculating the Premium Tax Credit
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