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 16, 2024, the last day of open enrollment in most states (some Marketplaces have a longer or different open enrollment window, so check with the Marketplace in your state). 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, when you receive advance premium tax credits (APTCs) through the marketplace, you are required to file an income tax return including IRS form 8962 to reconcile the APTCs that were paid on your behalf. If you do not file a tax return and reconcile the premium tax credits for two consecutive years, you will not be eligible for premium tax credits in the future. Note, however, that this rule has been suspended until the IRS builds the systems necessary to enforce the requirement. Therefore, you won’t be denied premium tax credits if you failed to file taxes and reconcile your premium tax credits for coverage you had in 2022 or a prior year.

Note: If you did file your return with IRS Form 8962, sometimes the Failure to Reconcile notice gets mailed out to people inadvertently because of IRS data delays. If you’re in this situation, you should log back into your Marketplace application and attest to having filed your tax return. A question appears asking if you reconciled your APTCs on your tax return for the past year, and you can attest, under penalty of perjury, that you did in fact file a tax return and reconcile past APTCs for all applicable years.

(CMS, Guidance on Annual Redetermination and Re-enrollment for Marketplace Coverage for 2024 and Later Years, 26 C.F.R. § 1.36B-2; IRS, Questions and Answers on the Premium Tax Credit).

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues