Individual Medical Plans

 Under the Affordable Care Act, eligibility for income-based Medicaid and subsidized health insurance through the Exchanges will be calculated using a household's Modified Adjusted Gross Income (MAGI). The Affordable Care Act definition of MAGI under the Internal Revenue Code and federal Medicaid regulations is shown below. For most individuals who will apply for health coverage under the Affordable Care Act, MAGI will be equal to Adjusted Gross Income.

Be sure to view the Marketplace App Checklist in our Resources section below. 

Premium Tax Credit

Advance Payments 

During enrollment, the Marketplace determines if you're eligible for advance payments of the premium tax credit. 

If you're eligible, you can choose to have ALL, SOME or NONE of the advance 

payments for which you are eligible sent to your insurance company: 

► ALL: the entire amount of your payments will be sent monthly to your insurance company

► SOME: a portion of your payments are paid in advance to your insurance company, and then you wait to receive the rest of the benefit of the premium tax credit for which you are eligible when you file your tax return

► NONE: you have nothing sent to your insurance company during the year, and 

wait to get all the benefit of the credit when you file your tax return 


If you or a family member enrolls in health coverage through the Marketplace for a month that you or the family member was not eligible for non-Marketplace health coverage, you may be allowed the credit if you: 

Paid your share of Marketplace insurance premiums 

Have household income within certain limits 

Do not file a married filing separately return. There are exceptions to this rule for domes­tic abuse and spousal abandonment victims 

Cannot be claimed as a dependent by another person 

You must file a federal tax return if either of these apply to you: 

• Advance credit payments were made on your behalf to your insurance company

• You are claiming the premium tax credit

Failing to file your tax return will prevent you from getting the benefit of advance credit payments in future years. 

Claiming and Reconciling the Credit 

When you file your tax return, you will use Form 8962, Premium Tax Credit, to claim the credit and to reconcile the credit with the advance credit payments made for you and your family. To reconcile the credit, subtract the total of your advance credit payments from the amount of the premium tax credit computed on your tax return. The difference will change the amount of tax you owe or the amount of your federal refund. 

Report life changes to the Marketplace 

Reporting life changes such as changes to income or family size - will help you avoid large differences between the advance credit payments made on your behalf and the amount of the premium tax credit you are allowed when you file your tax return. 

Did You Know...

If you or a member of your family enrolls in health insurance through the Marketplace, you may be eligible for the premium tax credit, a refundable credit that helps eligible individuals and families pay for health insurance. Please contact our office for valuable assistance.

 If you choose not to have advance credit payments made on your behalf, you will get the credit when you file your tax return. This will lower your tax balance due and could increase your refund.