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 has to have health insurance coverage. Your income tax return can help in paying for that 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
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 2019
For tax years before 2019, 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 was capped at the national average of the Marketplace’s bronze level premium.
Beginning after 2018, there is no longer a federal 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.
Most people who are eligible for the premium tax credit are also eligible for the Advance Premium Tax Credit. This is a monthly reduction of your health insurance premiums rather than waiting until you file your tax return to get the premium tax credit. When you prepare your tax return, you need to calculate if you received too much or too little premium tax credit through the advance payments. If you receive too much, you typically will need to pay it back. If you received too little then you will be eligible to receive the rest of it as a refundable tax credit. To be eligible for the premium tax credit 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
For tax year 2020, if you receive too much advance premium tax credit you do not need to pay it back.
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