QUESTION

I haven’t had any changes in my income or other family circumstances, and I want to keep my same plan. Why should I return to the marketplace?

Individuals with coverage | Individual and Marketplace Health Coverage
ANSWER

It is important that all enrollees return to the marketplace to update their account information and select a plan, even if they’ve had no life changes and want to keep their same plan. Even if your income and household size remain the same, other factors can impact the level of premium tax credit an enrollee receives. Federal rating rules permit insurers to increase premiums as people age, but because enrollees’ premium contributions are capped at a percentage of their income, their premium tax credit should increase to cover the higher age-adjusted premium. Moreover, the premium for the silver benchmark plan (second lowest cost silver plan) is used to determine the level of premium tax credit; if the premium goes up, then your premium tax credit also increases. If the premium for the silver benchmark plan goes down, then your premium tax credit goes down. You should return to the marketplace to update your account information and shop among your plan options to ensure you are getting the correct amount of subsidy and the best bang for your premium tax credit dollar.

Also, it’s especially important to update your information if you haven’t contacted the marketplace to update your information in the last two years and no IRS income information is available for the last two tax years. In this circumstance, the marketplace will discontinue premium tax credits and cost-sharing reductions unless you contact the marketplace and receive an updated re-determination for financial assistance. (45 C.F.R. § 155.335; CMS, Guidance on Reenrollments and Redetermination for Exchange Coverage for 2018, July 13, 2017).

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