Your cost for Marketplace health insurance is based on the income you file on your tax return. Your reported income also determines your eligibility for the tax credits associated with Marketplace health coverage. The tax system acts as a way for the government to provide assistance, by means of a tax credit, to those who need insurance but might not be able to afford it.
Minimum essential coverage
The Affordable Care Act mandates that everyone must share in the responsibility for health insurance. Your income tax return helps the government monitor your coverage. Minimal essential healthcare coverage can be acquired through one of the following venues:
- Health insurance through the healthcare Marketplace
- Health insurance coverage through your employer
- A government-sponsored program such as Medicare or Medicaid
- A health insurance policy directly from an insurance company
- Coverage under a plan that is approved by the Department of Health and Human Services
Remember, for healthcare options and eligibility information, visit TurboTax.com/health-care.
Modified adjusted gross income
If you choose to purchase a health plan through the Marketplace, you’ll need to estimate your household’s gross income. This is referred to as your modified adjusted gross income and includes all income from all sources including your spouse, if filing married. This amount should reflect your income on your tax return. It determines your eligibility for lower-cost health insurance premiums. When filling out the Marketplace application, include:
- Salaries and wages, including tips
- Social Security payments
- Net income from self-employment and business income
- Alimony payments
- Unemployment payments
Individual shared responsibility provision for tax years before 2018
For tax years before 2018, if you choose not to purchase health insurance coverage, you’re required to make an individual shared responsibility payment with your tax return. The annual payment is determined as a percentage of the declared amount of income on your tax return or a flat dollar amount. The 2018 individual shared responsibility payment is calculated as the greater of:
- A family flat dollar amount, which is $695 per adult and $347.50 for each child, with a maximum amount of $2,085, or;
- 2.5 percent of your household income above the threshold of your filing status.
The amount is capped at the national average of the Marketplace’s bronze level premium.
Not sure if you are exempt from the tax penalty or from the requirement to purchase health insurance? The TurboTax Exemption Check, is a free, online tool to help determine whether you might be eligible to waive the tax penalty entirely and apply for a health care exemption.
Beginning after 2018, there is no longer a tax penalty for not having health insurance.
Premium tax credit
You may be eligible to receive a premium tax credit if you obtain your health insurance from the Marketplace. This credit is to assist with monthly premium payments and is determined by the information on your tax return. To be eligible you must:
- Buy your health insurance through the Marketplace
- Be ineligible for a plan offered by the government or your employer
- Not be claimed as a dependent by another person
- Be within certain income limits
- Not have filed as married filing separately, except under certain circumstances
TurboTax can help you determine if you meet the eligibility requirements.