QUESTION

I understand eligibility for premium tax credits is based on our household income. Who counts as being in my household?

Individuals with no coverage | Eligibility for Premium Tax Credits and Cost-Sharing Reductions
ANSWER

A household, for purposes of determining eligibility for premium tax credits, includes any individuals for whom a taxpayer claims a personal exemption on the federal tax form. That includes yourself, your spouse, and dependents. Dependents include children who meet certain requirements:

  • U.S. citizen or resident of the U.S., Mexico or Canada;
  • Live with you for more than half the year (a child is considered to live with the taxpayer while he or she is temporarily away from home due to education, illness, business, vacation or military service);
  • Under age 19 at the end of the year, or under age 24 if a full-time student for at least five months of the year, or a child of any age if permanently and totally disabled; and
  • Doesn’t provide more than 50 percent of his or her own support.

Other individuals who can count as dependents include relatives, in-laws or full-time members of your household who are:

  • U.S. citizen or resident of the U.S., Mexico or Canada
  • Receive more than 50 percent of their support from you
  • Are related to you or live in your home all year
  • Make at least less than $4,050, generally excluding Social Security

A household can include individuals even if they are ineligible for tax credits (for example, individuals who are not lawfully present). Your household size can change during a year due to family changes, including the birth or adoption of a child, a child moving out of the house, and divorce or legal separation. When such changes take place you should report them to the marketplace as they may affect your eligibility for subsidies. Family changes also can trigger a special enrollment opportunity when you can change health plans outside of the regular open enrollment period.

Note that the definition of household for determining eligibility for premium tax credits sometimes differs from the definition of household for determining Medicaid eligibility. Ask your marketplace for more information about who should be counted in your household. (26 C.F.R. § 1.36B-2; Center on Budget and Policy Priorities, The Health Care Assister's Guide to Tax Rules, updated Sept. 2018; 45 C.F.R. § 155.420(d)).

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