The Basics
Q1. What is the premium tax credit? (updated February 24, 2022)
A1. The premium tax credit is a refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance purchased through the Health Insurance Marketplace, also known as the Exchange. The size of your premium tax credit is based on a sliding scale. Those who have a lower income get a larger credit to help cover the cost of their insurance. When you enroll in Marketplace insurance, you can choose to have the Marketplace compute an estimated credit that is paid to your insurance company to lower what you pay for your monthly premiums (advance payments of the premium tax credit, or APTC). Or, you can choose to get all of the benefit of the credit when you file your tax return for the year. If you choose to have advance payments of the premium tax credit made on your behalf, you will reconcile the amount paid in advance with the actual credit you compute when you file your tax return for the year. Either way, you will complete Form 8962, Premium Tax Credit (PTC) and attach it to your tax return for the year.
Note: For tax year 2020 only, you are not required to attach Form 8962 with your 2020 tax return unless your PTC is more than the APTC paid on your behalf for 2020 (called net premium tax credit or net PTC) and you are claiming net PTC. See link below for information specific to tax year 2020.
The credit is “refundable” because, if the amount of the credit is more than the amount of your tax liability, you will receive the difference as a refund. If you owe no tax, you can get the full amount of the credit as a refund. However, if advance credit payments were made to your insurance company and your actual allowable credit on your return is less than your advance credit payments, the difference, subject to certain repayment caps, will be subtracted from your refund or added to your balance due for tax years other than 2020. See the new Coronavirus Tax Relief section on this page for information specific to tax year 2020.
Q2. What is the Health Insurance Marketplace?
A2. The Health Insurance Marketplace, also called simply the Marketplace, is the place where you will find information about private health insurance options, purchase health insurance, and obtain help with premiums and out-of-pocket costs if you are eligible. The Department of Health and Human Services (HHS) administers the requirements for the Marketplace and the health plans offered. Generally, you purchase health insurance at the Marketplace during an open enrollment period. After an open enrollment period is over, individuals who experience certain life events may qualify for a special enrollment period to buy a health plan through a Marketplace. For details about who is eligible for a special enrollment period, for information about future open enrollment periods, and to learn more about the Marketplace, visit HealthCare.gov.
Q3. How do I get advance payments of the premium tax credit? (updated February 24, 2022)
A3. When you or a family member applies for Marketplace coverage, the Marketplace will estimate the amount of the premium tax credit that you may be able to claim for the tax year, using information you provide about your family composition, projected household income, and other factors, such as whether those whom you are enrolling are eligible for other, non-Marketplace coverage. Based upon that estimate, you can decide if you want to have all, some, or none of your estimated credit paid in advance directly to your insurance company to lower your monthly premiums. If you choose to have advance credit payments made on your behalf, you will be required to file Form 8962 with your income tax return to reconcile the amount of advance payments with the premium tax credit that you may claim based on your actual household income and family size, with an exception for certain taxpayers whose 2020 APTC is more than their 2020 PTC . See the Coronavirus Tax Relief section on this page for information specific to tax year 2020.
If you do not opt for advance credit payments or the Marketplace determines that you were not eligible for advance payments at the time of enrollment, you should determine if you are eligible to claim the credit because your circumstances changed during the year. To claim the credit, you must file Form 8962 when you file your tax return for the year, which will either lower the amount of taxes owed on that return or increase your refund.
Q4. What happens if my income, family size or other circumstances changes during the year? (updated February 24, 2022)
Q4. The actual premium tax credit for the year will differ from the advance credit amount estimated by the Marketplace if your family size or household income as estimated at the time of enrollment is different from the family size or household income you report on your return. The more your family size or household income differs from the Marketplace estimates used to compute your advance credit payments, the more significant the difference will be between your advance credit payments and your actual credit. Other changes in circumstances, such as marriage or divorce, may also affect your credit amount. If your actual allowable credit on your return is less than your advance credit payments, the difference, subject to certain repayment caps, will be subtracted from your refund or added to your balance due for years other than 2020. If your actual allowable credit is more than your advance credit payments, the difference will be added to your refund or subtracted from your balance due.
Notifying the Marketplace about changes in circumstances as soon as they occur will allow the Marketplace to update the information used to determine your expected amount of the premium tax credit and adjust your advance payment amount. This adjustment will decrease the likelihood of a significant difference between your advance credit payments and your actual premium tax credit. Changes in circumstances that can affect the amount of your actual premium tax credit include:
• Increases or decreases in your household income. Events that could result in a significant increase to household income include:
Lump sum payments of Social Security benefits, including Social Security Disability Insurance
Lump sum taxable distributions from an individual retirement account or other retirement arrangement Debt forgiveness or cancellation, such as the cancellation of credit card debt.
• Marriage
• Divorce
• Birth or adoption of a child
• Other changes to your household composition
• Gaining or losing eligibility for government sponsored or employer sponsored health care coverage
• Moving to another address Eligibility
Q5. Who is eligible for the premium tax credit? (updated February 24, 2022)
Q5. You are eligible for the premium tax credit if you meet all of the following requirements:
• Have household income that falls within a certain range (see Q7) or for 2021, you, or your spouse (if filing a joint return), received, or were approved to receive, unemployment compensation for any week beginning during 2021.
• Do not file a Married Filing Separately tax return ((unless you qualify for a special rule that allows certain victims of domestic abuse and spousal abandonment to claim the premium tax credit using the Married Filing Separately filing status (see Q9 and Q10);
• Cannot be claimed as a dependent by another person; and
• In the same month, you, or a family member:
o Enroll in coverage (excluding “catastrophic” coverage) through a Marketplace
o Are not able to get affordable coverage through an eligible employer-sponsored plan that provides minimum value (see Q11 and Q12)
o Are not eligible for coverage through a government program, like Medicaid, Medicare, CHIP or TRICARE
o Pay the share of premiums not covered by advance credit payments
Q6. Who is a family member for purposes of the premium tax credit?
A6. For purposes of the premium tax credit, your “family” consists of yourself, your spouse if filing jointly, and all other individuals whom you claim as dependents. Your “family size” is the number of individuals in your “family.”
Q7. What are the income limits? (Updated February 24, 2022)
A7. In general, individuals and families may be eligible for the premium tax credit if their household income for the year is at least 100 percent but no more than 400 percent of the federal poverty line for their family size. For tax year 2021, if a taxpayer or the taxpayer’s spouse (if filing a joint return), received, or was approved to receive, unemployment compensation for any week beginning during 2021, the amount of the taxpayer’s household income is considered to be no greater than 133 percent of the federal poverty line for his or her family size and the taxpayer is considered to have met the household income requirements for being allowed a premium tax credit.
For tax years 2021 and 2022, section 9661 of the American Rescue Plan Act of 2021 (ARPA), enacted on March 11, 2021, temporarily expanded eligibility for the premium tax credit by eliminating the requirement that a taxpayer’s household income may not be more than 400 percent of the federal poverty line. Under this rule, taxpayers with household income of more than 400 percent of the federal poverty line for their family size may be allowed to claim a premium tax credit, if otherwise eligible (see question 5).
Note: The federal poverty guidelines — sometimes referred to as the “federal poverty line” or FPL — state an income amount considered poverty level for the year based on family size. The Department of Health and Human Services (HHS) determines the federal poverty guideline amounts annually. The government generally adjusts the income limits annually for inflation. The Federal Register publishes a chart reflecting these amounts at the beginning of each calendar year. You can also find this information on the HHS website. HHS provides three federal poverty guidelines: one for residents of the 48 contiguous states and D.C., one for Alaska residents and one for Hawaii residents. For purposes of the premium tax credit, eligibility for a certain year is based on the most recently published set of federal poverty guidelines on the first day of the annual open enrollment period. For example, the tax credit for 2018 is based on the 2017 FPL. See the instructions for Form 8962 for more information.
See the Unemployment Compensation section: Questions 38 – 45 for information specific to unemployment compensation.
Q8. What is household income? (updated February 24, 2022)
A8. For purposes of the premium tax credit, your household income is your modified adjusted gross income plus that of every other member of your family (see Q6) who is required to file a federal income tax return. Modified adjusted gross income is the adjusted gross income on your federal income tax return plus any excluded foreign income, nontaxable Social Security benefits (including tier 1 railroad retirement benefits), and tax-exempt interest received or accrued during the taxable year. It does not include Supplemental Security Income (SSI). See Q41 and Q42 for information about unemployment compensation and household income.
If the source of your income is within Puerto Rico or was effectively connected with the conduct of a trade or business within Puerto Rico, the income is not included in your modified adjusted gross income and is not used in determining your household income. This limitation is specific to the computation of modified adjusted gross income for purposes of the premium tax credit. For additional information see Publication 570.
See the Unemployment Compensation section: Questions 38-45 for information specific to unemployment compensation.
Q9. Am I definitely ineligible for the premium tax credit if I’m married but I file my tax return using the filing status married filing separately? (updated February 24, 2022)
A9. No. If you are married and you file your tax return using the filing status married filing separately, you may be eligible for the premium tax credit if you meet the criteria in section 1.36B-2(b)(2) of the Income Tax Regulations, which allows certain victims of domestic abuse and spousal abandonment to claim the premium tax credit using the married filing separately filing status. You can claim this relief from the joint filing requirement if you meet all of the following criteria:
• You are living apart from your spouse at the time you file your tax return.
• You are unable to file a joint return because you are a victim of domestic abuse or spousal abandonment (see Q13).
• You certify on your return that you are a victim of domestic abuse or spousal abandonment.
To certify that you are a victim of domestic abuse or spousal abandonment and qualify for relief from the joint return filing requirement, you should check the box at the top of Form 8962, Premium Tax Credit (PTC), which you will use to claim the credit. You should not attach documentation of the abuse or abandonment to your tax return but should keep any documentation you may have with your tax return records. For examples of what documentation to keep, see Publication 974, Premium Tax Credit (PTC). Taxpayers may claim this relief from the joint filing requirement for no more than three consecutive years. For more information on this relief, see the instructions to Form 8962, Premium Tax Credit (PTC).
Note: Generally, a married taxpayer who lives apart from his or her spouse for the last six months of the taxable year is considered unmarried if he or she files a separate return, maintains as the taxpayer’s home a household that is also the main home of a dependent child for more than half the year, and furnishes over half the cost of the household during the taxable year.
Q10. For purposes of the relief from the joint filing requirement for certain victims of domestic abuse and spousal abandonment, how are domestic abuse and spousal abandonment defined?
A10. Domestic abuse includes physical, psychological, sexual, or emotional abuse, including efforts to control, isolate, humiliate, and intimidate, or to undermine the victim’s ability to reason independently. All the facts and circumstances are considered in determining whether an individual is abused, including the effects of alcohol or drug abuse by the victim’s spouse. Depending on the facts and circumstances, abuse of the victim’s child or other family member living in the household may constitute abuse of the victim.
A taxpayer is a victim of spousal abandonment for a taxable year if, taking into account all facts and circumstances, the taxpayer is unable to locate his or her spouse after reasonable diligence.
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