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 HealthCare.gov health insurance plan, you can report a 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 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. 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 you 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.

On March 27, 2020, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act which includes a one-time tax rebate payment to a majority of Americans as well as an increase of $600 per week to unemployment insurance (UI) benefits for up to four months, until July 31, 2020. Note that both the one-time tax rebate and the increase of $600 per week in UI benefits will be disregarded in the assessment for Medicaid and CHIP eligibility. The increased UI benefits, however, will be counted as income when applying for premium tax subsidies on the individual insurance market. For more information, see this FAQ from the Center on Budget and Policy Priorities.

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