QUESTION

When are you not eligible for premium tax credits?

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

In general, if you have any of the following types of coverage, you would be ineligible for premium tax credits through the marketplace:

  • Employer-sponsored coverage, unless the coverage is unaffordable (your required contribution to the premium for self-only coverage costs more than 9.86 percent of household income in 2019, for 2018 it was 9.56 percent) or does not meet minimum value (actuarial value covers less than 60 percent of total average costs of covered benefits);
  • Government-sponsored coverage, including Medicare Part A coverage, Medicare Advantage plans, most Medicaid coverage and the Children’s Health Insurance Program coverage, Veterans health coverage and TRICARE (coverage for members of the military);
  • Coverage for Peace Corps volunteers.

(26 C.F.R. § 1.36B; 26 C.F.R. § 1.36B-6; IRS, Rev. Proc. 2018-34).

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