QUESTION

I received a notice from the marketplace telling me I’m not eligible for automatic renewal with a tax credit. What should I do?

Individuals with coverage | Individual and Marketplace Health Coverage
ANSWER

You should go to the marketplace to update your information by January 15, 2022, the last day of open enrollment. The federal and most state marketplaces are not able to automatically re-enroll all enrollees. For example, if you did not authorize the marketplace to access your tax information in order to assess your eligibility for subsidies, you will have to return to update your information. The marketplace will ask you to project your income and household size and select a plan. You need to complete both steps in order to ensure you receive the correct amount of subsidy.

Additionally, if your most recent federal tax filing shows that your income is at a level that makes you ineligible for advance premium tax credits based on this year's plan options, you likely received a notice that, unless you return to the marketplace to actively re-enroll, you will be re-enrolled into coverage without any financial assistance. If your projected income has changed, you could be newly eligible for larger subsidies and should return to the marketplace to ensure they have the most accurate, up-to-date information so you can receive subsidies. Subsidies are calculated based on the price of available plans and household income; lower income individuals are eligible for greater subsidy amounts, and some higher income individuals may not receive subsidies.

The marketplace will also not automatically re-enroll enrollees with financial assistance if enrollees who received advanced premium tax credits in previous years failed to file their taxes for the years they received tax credits. Also, the marketplace will discontinue premium tax credits and cost-sharing reductions for enrollees receiving premium tax credits and cost-sharing reductions who have not contacted the marketplace to update their information for the last two years and no IRS income information available for them.

NOTE: Due to the impact of the COVID-19 pandemic, for plan years 2021 and 2022, you will not lose eligibility for premium tax credits if you did not reconcile your prior year’s premium tax credits.

(45 C.F.R. § 155.335; CMS, Guidance on Reenrollments and Redetermination for Exchange Coverage for 2018, July 13, 2017; CMS, Failure to File and Reconcile (FTR) Operations Flexibilities for Plan Years 2021 and 2022 – Frequently Asked Questions (FAQs)).

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