1. TurboTax /
  2. Tax Calculators & Tips /
  3. Tax Tips & Videos /
  4. ACA /
  5. Are Out-of-Pocket Medical Expenses Covered by ACA?

Are Out-of-Pocket Medical Expenses Covered by ACA?

Updated for Tax Year 2017


OVERVIEW

The Affordable Health Care Act offers a premium tax credit from 2014 onward to help with a portion, or all, of your out-of-pocket expenses, depending on your income. This tax credit did not apply to the 2013 tax year. The credit helps individuals and families with moderate income who purchase health insurance through the Health Insurance Marketplace. To determine your eligibility, you must file a tax return to establish your income.


Out-of-pocket expenses

“Out-of-pocket expenses” refers to money you spend on medical costs such as co-pays, coinsurance, deductibles and other similar payments associated with your essential health benefits. Any help with these expenses can only apply to plans purchased through the health insurance marketplace.

out of pocket medical expenses affordable care act

Costs incurred by using non-network and out-of-network providers, as determined by your plan, are not eligible to be covered as out-of-pocket expenses.

Cap on expenses

A limit is set on the amount of money you spend to maintain your health insurance plan through the marketplace. After you reach this amount, the insurance company is required to pay 100 percent of any additional costs for that year.

The government has set this limit on out-of-pocket expenses to ensure health care remains affordable. The maximum out-of-pocket expenditure, as of publication, is $6,350 for an individual and $12,700 for a family plan. However, it may be less, depending on the plan you choose and your annual income determined when you file your taxes.

Premium tax credit

The premium tax credit provides money to help individuals and families in moderate income brackets to afford their health insurance premiums. Your eligibility to receive the credit, and how much of a credit you are eligible for, is determined by your income when you file your taxes.

This tax credit only applies to insurance purchased through the marketplace.

If you opt to estimate your income and receive advance payments, any money that you are entitled to will be paid directly to your insurance company. Essentially, it works like a discount on your insurance premiums. If your income ends up being significantly higher than you estimated for the year, you may be asked to pay back some of the credit you received. This will come out of your tax return.

If you choose instead to receive your tax credit as a refund at tax time, it will either reduce the tax you owe at the end of the year, or boost your tax refund. You’ll pay for your insurance premiums on your own and be “paid back” for the credit, through your tax return.

Eligibility

To be eligible for the premium tax credit, and assistance with out-of-pocket costs, you must fit a number of criteria:

  • You must buy your insurance plan through the marketplace (If your plan is provided through your employer or the government, you don’t qualify.)
  • You must be within certain income limits. These are established when you do your tax filing.
  • If you’re married, you need to file a joint return.
  • And you can’t be claimed as a dependent on another tax return.

Remember, when you use TurboTax to prepare your taxes, we’ll ask you simple questions and handle these calculations for you.

Get every deduction you deserve

TurboTax Deluxe searches more than 350 tax deductions and credits so you get your maximum refund, guaranteed.

For only $54.99*
Sign In

Looking for more information?

The above article is intended to provide generalized financial information designed to educate a broad segment of the public; it does not give personalized tax, investment, legal, or other business and professional advice. Before taking any action, you should always seek the assistance of a professional who knows your particular situation for advice on taxes, your investments, the law, or any other business and professional matters that affect you and/or your business.


Security is built into everything we do
Here's how
* Important Offer Details and Disclosures
  • TURBOTAX ONLINE/MOBILE

  • Try for Free/Pay When You File: TurboTax online and mobile pricing is based on your tax situation and varies by product. Absolute Zero $0 federal (1040EZ/1040A) + $0 state offer only available with TurboTax Federal Free Edition; offer may change or end at any time without notice. Actual prices are determined at the time of print or e-file and are subject to change without notice. Savings and price comparisons based on anticipated price increase expected in March. Special discount offers may not be valid for mobile in-app purchases.
  • QuickBooks Self-Employed Offer with TurboTax Self-Employed: File your 2016 TurboTax Self-Employed return between 4/19/17 and 10/16/17 to receive your complimentary subscription to QuickBooks Self-Employed until 10/31/18. Activation by 12/31/17 required. Sign in to QuickBooks Self-Employed via mobile app or at https://selfemployed.intuit.com/turbotax; e-mail address used for activation and sign-in. Offer valid only for new QuickBooks Self-Employed customers. See QuickBooks.com for price comparison.
    • When you use TurboTax Self-Employed to file your 2017 taxes, you will have the option to renew your QuickBooks Self-Employed subscription. If you do not purchase TurboTax Self-Employed by 10/15/18, you will have the option of renewing your QuickBooks Self-Employed subscription by 10/31/18 for another year at the then-current annual subscription rate. You may cancel your subscription at any time from within the QuickBooks Self-Employed billing section.
  • Pays for itself (TurboTax Self-Employed): Estimates based on deductible business expenses calculated at the self-employment tax income rate (15%) for tax year 2016. Actual results will vary based on your tax situation.
  • Anytime, anywhere: Internet access required; standard message and data rates apply to download and use mobile app.
  • Fastest refund possible: Fastest tax refund with e-file and direct deposit; tax refund time frames will vary.
  • Pay for TurboTax out of your federal refund: $X.XX Refund Processing Service fee applies to this payment method. Prices are subject to change without notice.
  • TurboTax Expert Help, Tax Advice and SmartLook: Included with Deluxe, Premier and Self-Employed (via phone or on-screen); not included with Federal Free Edition (but available for purchase with the Plus bundle). SmartLook on-screen help is available on a PC, laptop or the TurboTax mobile app. TurboTax experts provide general advice, customer service and product help; tax advice provided only by credentialed CPAs, enrolled agents and tax attorneys. Feature availability varies by device. State tax advice is free. Service, area of expertise, experience levels, hours of operation and availability vary, and are subject to restriction and change without notice.
  • Tax Return Access, My Docs and My Analysis & Advice features: Access to all tax-related documents we have on file for you is available until you file your 2017 tax return or through 10/31/2018, whichever comes first. Terms and conditions may vary and are subject to change without notice.
  • #1 best-selling tax software: Based on aggregated sales data for all tax year 2015 TurboTax products.
  • Most Popular: TurboTax Deluxe is our most popular product among TurboTax Online users with more complex tax situations.
  • CompleteCheck: Covered under the TurboTax accurate calculations and maximum refund guarantees.
  • #1 rated online tax prep provider: Based on independent comparison of the best online tax software by TopTenReviews.com March 13, 2017.
  • TURBOTAX CD/DOWNLOAD SOFTWARE

  • TurboTax CD/Download products: Price includes tax preparation and printing of federal tax returns and free federal e-file of up to 5 federal tax returns. Additional fees apply for e-filing state returns. E-file fees do not apply to New York state returns. Savings and price comparison based on anticipated price increase expected in March. Prices subject to change without notice.
  • Fastest refund possible: Fastest tax refund with e-file and direct deposit; tax refund time frames will vary.
  • Pay for TurboTax out of your federal refund: $X.XX Refund Processing Service fee applies to this payment method. Prices are subject to change without notice. This benefit is available with TurboTax Federal products except TurboTax Business.
  • About our TurboTax Product Experts: Customer service and product support vary by time of year.
  • About our credentialed tax experts: Live tax advice via phone is included with Premier and Home & Business; fees apply for Basic and Deluxe customers. State tax advice is free. Service, experience levels, hours of operation and availability vary, and are subject to restriction and change without notice. Not available for TurboTax Business customers.
  • #1 best-selling tax software: Based on aggregated sales data for all tax year 2016 TurboTax products.
  • Data Import: Imports financial data from participating companies; may require a free Intuit online account. Quicken and QuickBooks import not available with TurboTax installed on a Mac. Imports from Quicken (2016 and higher) and QuickBooks Desktop (2012 and higher); both Windows only. Quicken import not available for TurboTax Business. Quicken products provided by Quicken Inc., Quicken import subject to change.