QUESTION

Who is eligible for marketplace premium tax credits?

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

Premium tax credits are available to U.S. citizens and lawfully present immigrants who purchase coverage in the marketplace. In general, individuals must also have household income between 100 percent and 400 percent of the federal poverty level, but for 2021 but for and 2022, there is no limit on household income eligible for premium tax credits. Premium tax credits are also available to lawfully residing immigrants with incomes below 100 percent of the poverty line who are not eligible for Medicaid because of their immigration status. (Generally, immigrants must lawfully reside in the U.S. for five years before they can become eligible for Medicaid.)

In addition, to be eligible for the premium tax credits, individuals must not be eligible for public coverage—including most Medicaid, most Children’s Health Insurance Program coverage, Medicare, or military coverage—and must not have access to affordable, adequate health insurance through an employer. There are exceptions to when you can apply for premium tax credits when you have other coverage. For example, there is an exception in cases when the employer plan is unaffordable because the employee’s share of the premium exceeds 9.61 percent of the employee’s household income in 2022 (for 2021, it was 9.83 percent). There is also an exception in cases where the employer plan doesn’t meet a minimum value (the plan must cover at least 60 percent of the cost of covered services for a standard population, and it must include substantial coverage of physician and inpatient hospital services). (26 C.F.R. 1.36B-6; 26 U.S.C. §36B; IRS Revenue Procedure 2021-36).

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