QUESTION

What happens if I don’t return to the Marketplace to update my application?

Individuals with coverage | Individual and Marketplace Health Coverage |
ANSWER

In most states and if eligible, the Marketplace will automatically re-enroll you into the same or a similar Marketplace health plan with a re-determination of premium tax credit eligibility based on the latest information they have through federal data sources. However, if you have been receiving advanced premium tax credits (APTCs), as a general rule you must file your tax return AND reconcile your premium tax credits using IRS Form 8962 for every year you received premium tax credits. 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. (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