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 their federal sources. However, for enrollees who have not contacted the marketplace to update their information for the last two years and no IRS income information is available for the previous two tax years, the marketplace will discontinue premium tax credits and cost-sharing reductions unless the enrollee contacts the marketplace and receives an updated re-determination. Also, the price of the benchmark plan may have changed, meaning that your premium tax credit amount has changed.

In general, you must file your tax return AND reconcile your premium tax credits using Form 8962 every year you received premium tax credits. If your premium tax credit amount turns out to be less than what you’re actually eligible for, you will have to pay more in premiums than you should have to. Conversely, if your premium tax credit turns out to be more than what you’re actually eligible for, you will have to repay all or part of the difference when you file your tax return. However, due to the impact of the COVID-19 pandemic, for plan years 2021 and 2022 you will not lose eligibility for premium tax credits if you did not reconcile your prior year’s premium tax credits. It is still important to contact the marketplace to update your application so that you’re receiving the correct amount of subsidy and the best coverage for your premium tax credit dollar.

(CMS, Guidance on Reenrollments and Redetermination for Exchange Coverage for 2018, July 13, 2017; CMS, Guidance on Reenrollments and Redetermination for Exchange Coverage for 2019 and Later Years).

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