QUESTION

My hours at work were cut back due to the COVID-19 pandemic, resulting in a temporary loss of income. Can I qualify for premium tax credits?

Individuals with coverage | Post enrollment issues | Coverage for Employees of a Large Employer Coverage for Employees of a Small Employer Employer-Sponsored Coverage
ANSWER

Possibly.

If you are already enrolled in a marketplace plan (either through HealthCare.gov or your state's marketplace), you should report the change in income. If you previously qualified for premium tax credits, and your income loss qualifies you for additional tax credits, you will be able to adjust how much of your tax credit you apply towards each month’s premium. If you are newly eligible for premium tax credits, you should qualify for a special enrollment period and will be able to switch your health plan within the same metal level of your current health plan. If your income has fallen to between 100 and 250 percent of the federal poverty level, you can switch to a silver-level plan in order to benefit from the cost-sharing reduction subsidies to lower your copayments and deductibles.

If you are enrolled in an individual market plan outside of the marketplace and experience an income reduction that makes you newly eligible for premium tax credits, in most states you are eligible to enroll in marketplace coverage and access financial assistance. See this FAQ for more information.

If you are currently enrolled in job-based insurance and your lost hours made you ineligible for your employer’s plan, you will qualify for a special enrollment period for 60 days from the day you lost eligibility for your job-based insurance (although there may be an extension for exceptional circumstances), and depending on your income level, you might qualify for premium tax credits to subsidize your monthly premiums. You may also be eligible for your job’s COBRA benefits to extend your job-based benefits. See our FAQ on COBRA benefits to weigh the pros and cons of opting for COBRA or switching to an individual market health insurance plan.

If you are currently uninsured, your ability to qualify for a special enrollment period and/or premium tax credits will depend on the state in which you live. To find more information, see our FAQ on being uninsured during the COVID-19 pandemic. Note that for your state health insurance marketplace, your income is a projection of what you expect to make over the entire year. If your projected income is lower than the actual income you report on your 2020 tax return, you may owe back a portion or all of the premium tax credits received. You will not have to pay back cost-sharing reduction subsidies. If your current income is at or below 138 percent of the federal poverty level, you may be eligible for Medicaid, depending on the state in which you live.

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