In order to see if you will qualify for the Advanced Premium Tax Credit you must provide information about your household and income.
- For most people, a household consists of the tax filer, their spouse if they have one, and their tax dependents, including those who don’t need coverage.
- If you plan to claim someone as a tax dependent for the year you want coverage, do include them on your application.
- If you won’t claim them as a tax dependent, don’t include them.
- Include all of these people even if they don’t need health coverage.
What income is counted?
The Marketplace uses an income number called modified adjusted gross income (MAGI) to determine eligibility for savings. It’s not a line on your tax return.
Your MAGI is the total of the following for each member of your household who’s required to file a tax return:
- Your Adjusted Gross Income (AGI) on your federal tax return
- Excluded foreign income
- Nontaxable Social Security benefits (including tier 1 railroad retirement benefits)
- Tax-exempt interest received or accrued during the tax year
- MAGI does not include Supplemental Security Income (SSI)
How do I estimate my income?
When you fill out a health insurance application and use some tools on this website, you’ll need to estimate your expected income for 2016. Two important things to know:
- Marketplace savings are based on your expected household income for 2016, not last year’s income.
- Income is counted for you, your spouse if married, and everyone you’ll claim as a tax dependent on your 2016 federal tax return who’s required to file a tax return. Include their income even if they don’t need health coverage.
Who to include in your household
|Relationship||Include in household?||Notes|
|Dependent children, including adopted and foster children||Yes||Include any child you’ll claim as a tax dependent, regardless of age.|
|Children, shared custody||Sometimes||Include children whose custody you share only during years you claim them as tax dependents.|
|Non-dependent child under 26||Sometimes||Include them only if you want to cover them on your Marketplace plan.|
|Children under 21 you take care of||Yes||Include any child under 21 you take care of and who lives with you, even if not your tax dependent.|
|Unborn children||No||Don’t include a baby until it’s born. You have up to 60 days after the birth to enroll your baby.|
|Dependent parents||Yes||Include parents only if you’ll claim them as tax dependents.|
|Dependent siblings and other relatives||Yes||Include them only if you’ll claim them as tax dependents.|
|Spouse||Yes||Include your legally married spouse, whether opposite sex or same sex. Married couples must file taxes jointly to qualify for savings.|
|Legally separated spouse||No||Don’t include a legally separated spouse, even if you live together.|
|Divorced spouse||No||Don’t include a former spouse, even if you live together.|
|Spouse, living apart||Yes||Include your spouse unless you’re legally separated or divorced. (See next row for an important exception.)|
|Spouse, if you’re a victim of domestic abuse, domestic violence, or spousal abandonment||Not required||In these cases, you don’t have to include your spouse.See rules for victims of domestic abuse, domestic violence, or spousal abandonment.|
|Unmarried domestic partner||Sometimes||Include an unmarried domestic partner only if you have a child together or you’ll claim your partner as a tax dependent.|
|Roommate||No||Don’t include people you just live with — unless they’re a spouse, tax dependent, or covered by another exception in this chart.|
What’s the fee for not having health coverage in 2016?
If you don’t have health insurance in 2016, you’ll pay the higher of these two amounts:
- 5% of your yearly household income(Only the amount of income above the tax filing threshold, about $10,150 for an individual in 2014, is used to calculate the penalty.) The maximum penalty is the national average premium for a Bronze plan.
- $695 per person ($347.50 per child under 18)The maximum penalty per family using this method is $2,085.
How you pay the fee
- You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage. Most people will file their 2016 returns in early 2017.
- If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured.
- If you’re uninsured for no more than 2 months of the year, you don’t have to make a payment.
Important dates for 2016 enrollment
- November 1, 2015: Open Enrollment starts — first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2016.
- December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016.
- January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15.
- January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
- January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.
If you don’t enroll in a 2016 health insurance plan by January 31, 2016, you CANNOT enroll in a health insurance plan for 2016 unless you qualify for a Special Enrollment Period with a qualifying life event. Some of the common qualifying life events are:
- Getting married, having a baby
- Losing other job based insurance coverage (voluntarily dropping coverage doesn’t qualify)
- Your job based plan not meeting the minimum requirements
- Aging off of a parents plan (turning 26)
- COBRA coverage ending
- Having a change in household income