QUESTION

If I’m eligible for other coverage but haven’t enrolled in it yet, can I qualify for premium tax credits in the marketplace?

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

For certain types of coverage, if you are eligible but not enrolled, then you can still qualify for premium tax credits. These include:

  • Retiree health coverage offered by a former employer
  • COBRA coverage (when offered after losing your job)
  • Student health plan coverage
  • Medicare Part A coverage requiring payment of premiums

However, if you are eligible for job-based coverage (that is affordable and meets minimum value) or for Medicaid or CHIP, but you didn’t enroll, then you are not eligible for premium tax credits. Note that if you are eligible for COBRA because you had a reduction in hours at work, you will need to show that the COBRA coverage is unaffordable or fails to meet minimum value in order to be eligible for premium tax credits. (26 C.F.R. § 1.36B-2(b) and (c); 77 Fed. Reg. 30377, May 23, 2012; IRS, Questions and Answers on the Premium Tax Credit).

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