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I am on Medicare and Social Security. My wife is self employed and needs insurance from the state exchange. How do we figure our household income?

The exchange will determine what percentage of your total household income is necessary to cover the full-price cost of the ACA benchmark plan for your spouse. | Image: StockImageFactory /

Q. I am on Medicare and Social Security, my wife recently became self-employed and needs health insurance from the state exchange, as she’s not yet old enough to qualify for Medicare. How do we figure our household income? Does my social security count toward household income, even though I will not be buying insurance?

A. For the purpose of determining subsidy eligibility, here’s the formula that’s used to calculate modified adjusted gross income (MAGI). MAGI is based on household income, even if only one spouse is applying for a policy in the exchange.

Keep in mind that subsidy eligibility is a function of income related to the poverty level. Although your total household income is obviously higher than your wife’s income alone, the poverty level for a household of two is also higher than the poverty level for a household of one.

What are the income limits for ACA subsidy eligibility?

For 2020 coverage, the upper income limit for a household of one to receive subsidies is $49,960. (Here’s how household income is calculated under the ACA.) For a household of two, it’s $67,640.

So while your income is counted when determining whether she’ll qualify for a subsidy, you’re also counted as part of the household when determining how the household’s income compares with the poverty level.

The exchange will look to see what percentage of your total household income is necessary to cover the full-price cost of the benchmark plan for your wife. If it’s more than the percentage of income that people are expected to pay for their coverage, she’ll qualify for a premium subsidy. But the amount that you pay for your Medicare coverage will not be counted; they will only look at how much your wife’s policy costs in relation to your total household income. Here are some examples of how differing family sizes affect total subsidy amounts, as it can sometimes be a bit counter-intuitive.

In order to qualify for a subsidy, married applicants must file joint tax returns. If your wife experienced a qualifying event (for example, losing her employer-sponsored plan when she became self-employed), she can enroll in the exchange during the special enrollment period triggered by her qualifying event. If not, she’ll have access to individual market plans when open enrollment begins again on November 1.

Your wife can use your most recently filed tax return to provide income information to the exchange. But if your household income has changed significantly as a result of her recent self-employment, she can instead provide the exchange with an estimated projection of your household income, and then provide updates to the exchange later on if her income changes again.

For any year that she receives advance premium tax credits (subsidies) during the year (or if she pays full price through the exchange but ends up with a household income that makes her subsidy-eligible), she’ll need to use Form 8962 to reconcile her subsidy on your joint tax return.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Jacqueline Kelly
Jacqueline Kelly
1 year ago

Regarding the above situation, it is similar to my own, this is the first time I am seeking a credit on I believe to be overpayment of premiums, but when my husband is filing his taxes showing our earnings which are within the threshold for a couple it shows no refund, I am not sure why. Although I’ve checked on the marketplace it says different when I fill out the information as a reference. Is this because my husband is on Medicare so I am being seen as only one and not entitled to a lower premium or refund after all.

Louise Norris
Louise Norris
1 year ago

When you’re a household of two, the premium for just yourself is compared with your total household income to determine if you qualify for a subsidy (and they also use the poverty level for a household of two, so potential subsidy eligibility does extend to a higher income in that situation). It’s based on keeping your premium in the exchange (in this case, for just yourself) at the percentage of your household income that’s considered affordable. (you can see more about those percentages here: )
So yes, the subsidy is much smaller if only one spouse is enrolling through the exchange, because the pre-subsidy premium for just one person is less than it would be for two people. Have you completed Form 8962 yet? It will show you the price of the benchmark plan in your area, the price of the plan you purchased, and the amount of premium subsidy — if any — that you should receive.

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