What happens if my income changes and my premium subsidy is too big? Will I have to repay it?


Q: What happens if my income changes and my premium subsidy is too big? Will I have to repay it?

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A: Monthly premium subsidy amounts (ie, the advance premium tax credit – APTC – that’s paid to your insurer each month to offset the cost of your premium) are estimated based on prior-year income and projections for the year ahead, but the actual premium tax credit amount to which you’re entitled depends on your actual income in the year that you’re getting subsidized health insurance coverage.

If recipients end up earning more than anticipated, they could have to pay back some of the subsidy. This can catch people off guard, especially since the tax credits are paid directly to the insurance carriers, but if overpaid, they must be returned by the insureds themselves.

The issue of reconciling APTCs was explained in a 2013 IRS publication (see the final column on page 30383, continued on page 30384) which clearly explains that they do expect people to pay back subsidies that are in excess of the actual amount for which the household qualifies.

But the portion of an excess subsidy that must be repaid is capped for families with incomes up to 400 percent of federal poverty level (FPL). Details regarding the maximum amount that must be repaid, depending on income, are in the instructions for Form 8962, on Table 5 (Repayment Limitation).

There are some scenarios in which repayment caps do not apply:

  • If a person projected an income below 400 percent of the poverty level (and received premium subsidies during the year based on that projection) but then ends up with an actual income above 400 percent of the poverty level (ie, not eligible for subsidies), the entire subsidy amount that was paid on their behalf has to be repaid to the IRS.
  • If a person projected an income at or above 100 percent of the poverty level (and received premium subsidies) but then ends up with an income below the poverty level (ie, not eligible for subsidies), none of the subsidy has to be repaid. This is confirmed in the instructions for Form 8962, on page 8, in the section about Line 6 (Estimated household income at least 100% of the federal poverty line).

But there are new rules as of 2019 that make it less likely for people with income below the poverty level to qualify for premium subsidies based on income projections that are above the poverty level. This is explained in more detail here.

The IRS noted that they would “consider possible avenues of administrative relief” for tax filers who are struggling to pay back excess APTC, including such options as payment plans and the waiver of interest and penalties for people who must return subsidy over-payments. If you find yourself in a situation where you must pay back a significant amount of the premium subsidies you received during the prior year, contact the IRS to see if you can work out a favorable payment plan/interest arrangement.

GOP lawmakers considered various proposals in 2017 that would have eliminated the repayment limitations, essentially requiring anyone who received excess APTC to pay back the full amount, regardless of income. But those proposals were not enacted.

How many people have to repay subsidies?

For 2015 coverage, subsidies were reconciled when taxes were filed in early 2016. The IRS reported in early 2017 that about 3.3 million tax filers who received APTC in 2015 had to repay a portion of the subsidy when they filed their 2015 taxes; the average amount that had to be repaid was about $870, and 60 percent of people who had to pay back excess APTC still received a refund once the excess APTC was subtracted from their initial refund. [IRS data for premium tax credit reporting is available here; as of 2019, data had only been reported for the 2014 and 2015 tax years.]

But on the opposite end of the spectrum, about 2.4 million tax filers who were eligible for a premium tax credit ended up receiving all or some of it when they filed their return. These are people who either paid full price for their exchange plan in 2015 but ended up qualifying for a subsidy based on their 2015 income, or people who got an APTC that was less than the amount for which they ultimately qualified. The average amount of additional premium tax credit paid out on tax returns for 2015 was $670.

[The IRS noted that it was very uncommon for people to pay full price for their coverage and wait to claim their full refund on their return: 98 percent of the people who claimed a premium tax credit on their return had received at least some APTC during the year.]

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Robin
Guest
Robin

I was in formed by my I seance that I no longer receive a subsidy for my insurance premium and now they are telling me I own 1700 a month for the insurance. I have been receiving a subsidy for a few years and it always carried over I don’t understand what changed this year. I did not change companies either

Louise Norris
Editor

Hi Robin, I’d need more details to tell you exactly what happened with your subsidy. It’s based on your age, your zip code, the number of people in your tax household (and how many of them are enrolling in the plan), and your income. You can play around with our subsidy calculator to see how changing those factors affects the subsidy amount: https://www.healthinsurance.org/obamacare/subsidy-calculator/ From one year to the next, your subsidy eligibility and amount can change if the cost of the benchmark plans (second-lowest-cost silver plan) in your area changes. So it’s possible that a new, lower-cost insurer entered the… Read more »

Waltlasher@ymail
Guest
Waltlasher@ymail

To whom it may concern… My wife is disabled, and it took 3 years for her to qualify for benefits which left us in a tough situation living on one income,further complicated by the fact that l could qualify as disabled myself but both of us could not have survived without at least one person working. So we somehow made it through,but now must spend a large portion of her back pay repaying the subcity that was extended to us! What can we do to minamize the damages without distroying our credit scores? And falling back into debt again.

Louise Norris
Guest

This is a tough situation. My best recommendation is that you reach out to the IRS directly and ask them to help you establish a payment plan that will allow you to repay the excess premium tax credit on terms that will work with your finances. Excess premium tax credits can be collected by the IRS just like any other tax debt (unlike the individual mandate penalty, which has much more limited collection procedures), but the IRS has shown a willingness to work with tax filers to make it manageable: https://www.treasury.gov/tigta/auditreports/2016reports/201633071fr.pdf

Lorraine J Costanzo
Guest
Lorraine J Costanzo

I underestimated my income for Healthcare subsidy by $4796. I estimated income at $16800. and it turned out to be $21872. because I worked 2 months before retiring.. will I have to payback the whole subsidy or the $4796. ?? I can’t believe I’ll be in debt again over this ! Thank you for your help.

Louise Norris
Editor

Hi Lorraine, You should only have to pay back at most $300 of your subsidy. You’ll use Form 8962 to reconcile your subsidy when you file your taxes. The instructions for that form are here: https://www.irs.gov/pub/irs-pdf/i8962.pdf (see Table 5 on page 16 of the instructions). The form will help you to calculate what your subsidy should have been (based on an income of $21,872), and then they’ll compare it with the subsidy that was paid on your behalf during the year. They do have a repayment requirement if it turns out that your subsidy was too large, but they have… Read more »

Lorraine J Costanzo
Guest
Lorraine J Costanzo

Thank you so much for the reply !

Michelle
Guest
Michelle

So, last year I had mass health for part of the year, but then I ended up earning way more than I thought I was going to for the entire year. So pretty much I shouldn’t have had mass health but forgot to report my earnings. Am I going to be fined on my taxes and if so what will happen?

Jack
Guest
Jack

Am I correct with that understanding that the tax credit is based on the total yearly income and not just the months I needed marketplace coverage? I worked a temp job for a few months and enrolled in the marketplace. My income for those months was accurately reported. However, when I was found a full-time job with insurance I no longer needed the marketplace and my income went up. Now it appears I have to repay the tax credits even though when I was enrolled in the marketplace my income made me eligible. Seems the tax credits and my income… Read more »

Louise Norris
Guest

Eligibility for Medicaid is calculated in real-time, based on current monthly income. But it’s different for premium subsidies. They’re a tax credit, and they have to be reconciled on your tax return based on your total annual income. They do prorate it on a monthly basis, so it’s possible to get a premium tax credit for just a few months, as long as your total income for the year doesn’t exceed 400% of the poverty level. But if you exceed that threshold, there’s no premium subsidy available, even if you earned all of your income during just a small portion… Read more »

Jack
Guest
Jack

Very helpful. Thank you!

Stephanie
Guest
Stephanie

How does that work? My husband was out of work for 8 months and purchased health insurance for those 8 months for which we received a tax credit. Once he was employed we terminated the insurance. His employment and my new job with a higher salary has us looking at repaying most of that tax credit even though our income was very low during those months.

Stephanie
Guest
Stephanie

I should clarify that my new job started AFTER we terminated the insurance.

Louise Norris
Editor

It’s frustrating to be in that situation, for sure. But it’s a tax credit based on annual income, regardless of when the income is earned during the year. If they hadn’t made it an advanceable tax credit, people would have had to wait until they filed their tax return to claim any of it. But it would be unrealistic to expect most people to be able to front the whole cost throughout the year, and then get the whole tax credit as a refund from the IRS. So they allow people to take it in advance, throughout the year –… Read more »

Dawn
Guest
Dawn

Unfortunately, this exact same scenario just happened to me and my husband. We had a significantly different income while using the subsidies. As soon as our income changed and my husband found another job, we stopped ACA, but we just found out we still have to pay based on our income for the year whether we stopped it or not. Very disheartening to find out how much we now owe the IRS for just 3 months of coverage.

Louise Norris
Editor

I’m sorry you’re in this situation, Dawn. This is indeed one of the more frustrating aspects of the premium subsidy system, since it can be challenging to accurately predict income for the whole year when an employment situation is in flux. Some people find that it’s easier to understand the repayment of excess subsidies if they keep the perspective that the subsidy is just a tax credit. If it worked like other tax credits and could only be claimed on a person’s tax return, there would be no subsidy for a person whose income ended up above 400% of the… Read more »

MaryAnn
Guest
MaryAnn

It’s outrageous Dawn and a complete rip off. You have to pay for the insurance. It only seems to benefit the very poor.

Maryann
Guest
Maryann

Jack, I am in the same situation. My income for the first six months through June was $29,000. In July I reported an increase in income. I estimated it to be maybe around $47,000. I decided to cancel it on October 9th, because I was not being given correct information and I was afraid of paying money back. No one told me that I could not go over $49,000 for the year as a single person. I thought after I cancelled, I would not have to include Nov through Dec income which put me over… part of it included unemployment.… Read more »

Joyce
Guest
Joyce

We went over the poverty level by just a couple of thousands. We are self-employed and underestimated our income, now the IRS is making us pay back over $12000.00 for one year and $14000.00 for another year. We can’t pay that much back at one time and now they are charging penalties and interest on top of that and we will never get this paid off. Is there any help with this?

Louise Norris
Editor

Hi Joyce, This is a tough situation, for sure. I assume you meant you went over 400% of the poverty level, and thus have to pay back the entire subsidy? If one of the years in question is 2019, you may still be able to reduce your MAGI to get it into the subsidy-eligible range by making contributions to your retirement accounts. Here’s how that works: https://www.healthinsurance.org/faqs/with-my-income-im-barely-over-the-eligibility-limit-for-a-premium-subsidy-is-there-anything-i-can-do-to-lower-my-income-so-i-become-eligible/ For years before 2019, I don’t think there’s much you can do to change your income or the subsidy repayment amount. But you can reach out to the IRS directly and ask them… Read more »

Brandi Trella
Guest
Brandi Trella

For a family of 3 we only used the APTC for 4 months. We were anticipating making 62,000 but I got a new job and we made 72,000. this still puts us at 357% of poverty level. What will we owe?

Louise Norris
Editor

When you complete Form 8962, you’ll figure out what your premium tax credit should have been, based on 357% of the poverty level. You’ll have to repay the difference to the IRS. But with an income of 357% of the poverty level, the most you’ll have to repay is $2,650, regardless of how much your APTC overage actually ended up being — see Table 5 in the instructions for Form 8962: https://www.irs.gov/pub/irs-pdf/i8962.pdf

Tony
Guest
Tony

Hi, I overpaid for my Obamacare, not underpaid. I thought my annual income would be more than double what it actually was. Will I get a big tax refund as a result?

Louise Norris
Editor

The amount of your subsidy will be adjusted to reflect your actual income when you file your taxes. As long as your income was still in the subsidy-eligible range (ie, not so low as to be Medicaid-eligible), the additional premium tax credit that you should have received will be given to you by the IRS as a lump sum. Assuming we’re talking about 2019, this subsidy calculator tool will show you what your subsidy amount should have been, so you can get an idea of how much you might receive: https://www.kff.org/interactive/subsidy-calculator-2019/ You’ll use IRS Form 8962 to reconcile your premium… Read more »

wendy
Guest
wendy

We had the subsidy for 2018 for the entire year, but in November a family property that my brother and I inherited , which was sold , but owner financing. The new owner decided to pay the loan off-which but us way over 400%- we now owe the entire subsidy back $32,000.00. We would not of had insurance for those previous months, but for the unexpected sale we are penalized. We would not mind just having to pay back for the two months, but it is not fair to pay for the entire year.

Louise Norris
Guest

I’m sorry you’re in a tough spot with this. But the premium subsidy is a tax credit and eligibility is based on your annual income — regardless of whether that income comes in steadily throughout the year, or in a lump sum. The way the IRS (and the ACA) looks at it, your income for the year ended up being high enough that you can afford to pay for coverage on your own, without a tax credit. In reality, that might be far from the truth… I don’t know the specifics in terms of how much your income actually ended… Read more »

Paula
Guest
Paula

We have to pay back the APTC and have a payment arrangement. I notice the IRS is adding penalties and interest. I thought it was determined the ACA could not be considered a tax; and, therefore, would not be treated as such. How are they charging interest and penalties?

Louise Norris
Editor

The Supreme Court ruled in 2012 that it is a tax, and is thus constitutional because it’s within Congress’s powers of taxation (here’s that ruling: https://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf ) — Incidentally, this is the crux of the current lawsuit in which 18 GOP-led states are seeking to overturn the entire ACA (including the protections for people with pre-existing conditions, and the subsidies the law provides). They’re arguing that without the tax (which was eliminated at the start of 2019), the individual mandate is unconstitutional, and thus the entire law ought to be overturned. But getting back to the penalty/tax. Even though SCOTUS… Read more »

Dean
Guest

I will lose my employer health care in May (year 2020) and will decide to enroll in Obamacare at that point. I will qualify for a subsidy on my premiums based on my current projected income. However this coming December, (year 2020) I will take a retirement distribution from my 401K (to buy a house) that will put my income over the 400 percent of the poverty level to receive a subsidy for the year. Now at the end of the year, will I have to pay back all of the tax credit from May to the end of the… Read more »

Louise Norris
Editor

We always recommend that you consult with a tax advisor about your specific circumstances. But as general background, premium tax credit eligibility is based on your income for the full year. (Note that income refers to an ACA-specific MAGI calculation: https://www.healthinsurance.org/glossary/modified-adjusted-gross-income-magi/ ).
If your MAGI goes over 400% of the poverty level (based on the *prior* year’s poverty level numbers), you ultimately won’t be eligible for any subsidy at all for the whole year, which means you’d have to pay it all back. This is true even if all of your income is received on the last day of the year.

Al Badoux
Guest
Al Badoux

I qualified for tax assistance and joined the Marketplace Health Care Plan as of January 2019. In December 2019 I received a back pay settlement check from the government for my disability claim which was filed mid 2016. Upon filing 2019 taxes I was told I need to repay $9000.00 to cover the subsidies. I have no issues paying from the date I became “Unqualified” for help (Dec 2019) but dont feel I must pay for the previous 11 months as I was intact qualified low income. Any thoughts on this ??

Louise Norris
Guest

Unfortunately, there’s not really a way around this. Premium subsidies are a tax credit based on annual income (as opposed to Medicaid eligibility, which is based on monthly income). With other income-based tax credits, eligibility is determined after the end of the year, when you file your tax return and your income for the year is known. But people are allowed to take their premium tax credits in advance, throughout the year, paid directly to the insurance companies (there is also an option to pay full price and just claim the tax credit on your tax return, the way you… Read more »

MaryAnn
Guest
MaryAnn

it is very unfair. This Market place is designed to benefit the government or the very poor, not the middle class. We have no recourse to negotiate to even pay a portion back. This is seriously putting people in debt, and no one is explaining how this works until tax time comes. I will never apply for Obama Care again.

Randy
Guest
Randy

I was unemployed for the first 5 months last year and received 4200 in subsidies for that period. I was hired in May and cancelled Obama care in June and didn’t receive anymore subsidies. I went on to earn 32K the remainder of the year. What will I owe?

Louise Norris
Guest

I assume you projected an income of some amount for the year (even though you weren’t making an income for the first part of the year?) since you were found to be eligible for premium subsidies, which generally require an income of at least the poverty level. But reconciling your subsidy on your tax return is going to depend on how much your actual income for the year differs from the income that you projected when you enrolled in the health plan. If your actual income ended up quite a bit higher than you had projected, you’ll have to pay… Read more »

MaryAnn
Guest
MaryAnn

Once the insurance is cancelled, the money made up to that point should be considered, not the entire year. Many people are contractors and it is impossible to predict income for the year. So unfair.

j ab
Guest
j ab

will my inheritance from my dad affect my MAGI

Louise Norris
Editor

We recommend that you consult with a tax advisor who can give you detailed advice based on your specific circumstances. But in general, the federal estate tax is only applicable to multi-million dollar estates, and there’s not a federal inheritance tax: https://www.bankrate.com/taxes/do-you-have-to-pay-tax-on-inheritance/ But if you inherit assets which you then sell, you might end up with capital gains, which would be added to your income and thus increase your MAGI. It will basically come down to whether or not your AGI is affected by the inheritance. If it is, then your MAGI is likely to also be affected, as ACA-specific… Read more »

j ab
Guest
j ab

thank you

Mark
Guest
Mark

My tax program calculates that I have to pay an additional $1600 due to a higher income than expected. I understand this part. What I don’t understand is how to actually repay the government. Will this be deducted from my tax refund (slightly over $2000)? Or do I need to write a check?

Louise Norris
Editor

If you’re otherwise owed a refund, the repayment of the premium tax credit will just be subtracted from your refund. The subsidy is just like any other refundable tax credit, in that it will add to your refund if the credit paid on your behalf during the year was too small, and it will subtract from your refund if the credit paid on your behalf during the year was too large. (and people who wouldn’t otherwise get a refund and also have to pay back some or all of their premium tax credit are required to send the money to… Read more »

Mark
Guest
Mark

I guess my difficulty in understanding is that the 1120 only shows my refund due. You’re saying I just file everything and they IRS will deduct my subsidy correction and only refund the difference? i.e. I’m owed $2000 on the 1120 but I have to repay $1000 in subsidies will result in a $1000 refund check?

Lydia Fernandez
Guest
Lydia Fernandez

on my 2019 taxes I will receive a sizable refund, but I was over subsidized on my ACA by $497, will they deduct that from my refund or do I have to pay it back somehow

Louise Norris
Editor

Yes, they will deduct it from the refund you were due to receive. Depending on your income, they may not make you repay the entire amount of the excess premium subsidy. If you earned more than 400% of the poverty level, you’ll have to pay back the entire premium subsidy that was paid on your behalf. But if your income was less than 400% of the poverty level, the amount you have to pay back (ie, have subtracted from your refund) is capped at the amounts shown in Table 5 of the instructions for Form 8962: https://www.irs.gov/pub/irs-pdf/i8962.pdf (Table 5 is… Read more »

Greg
Guest
Greg

I am helping a couple do their taxes. They had insurance through the marketplace. They received their 1095 and it shows that they received healthcare worth 991 a month (with the listed silver plan at 1350 a month). They received a subsidy of $895 per month meaning they only paid $96 a month for insurance. They made more income than expected($90000) AGI putting them a 550% over the poverty line for their family of two. As I understand, they will have to pay back the entire subsidy of $10740($895 times twelve months). Does this seem to be correct?

Louise Norris
Editor

Yes, that’s correct. If their ACA-specific modified adjusted gross income ended up above 400% of the poverty level, they’ll need to repay all of the premium tax credit that was paid on their behalf in 2019.
Here’s how MAGI is calculated under the ACA: https://www.healthinsurance.org/glossary/modified-adjusted-gross-income-magi/
It’s unlikely that their MAGI can be brought down into the subsidy-eligible range, given how much above it they are. But here’s how that works, just in case: https://www.healthinsurance.org/faqs/with-my-income-im-barely-over-the-eligibility-limit-for-a-premium-subsidy-is-there-anything-i-can-do-to-lower-my-income-so-i-become-eligible/ I would recommend that they consult with a CPA, who might be able to find a way to make it work for them.

Mo
Guest
Mo

I was a student in college and under my parents insurance. I graduated and got a 60K job but continued to be under my parents insurance. Our tax person did not educate us of all these inusrance tax credit issues. 2 years later the IRS sends me a letter stating i owe them $30,000 (you read that right) for using obamacare in 2017 and 2018. Funny thing is i never used the insurance. I was 25 years old in 2017 and 26 in 2018, so i was eligible to use my parents insurance. Is there any way i can fight… Read more »

Mohammed Hussain
Guest
Mohammed Hussain

Worth to note that my tax accountant mentioned since i was 26 and younger, my dad is the primary insurace holder so he recieved all the premium credit. Since my father is low income, we should not owe anything. But the IRS is still coming after me. Any help is appreciated.

Thank you for this website. I searched the internet and this is the most useful info i could find.

Louise Norris
Guest

This is a tough situation, and I’m sorry you’re stuck in it! I’m guessing that your income combined with your parents’ income in 2017/2018 would have been more than 400% of the poverty level (ie, $81,680 in 2018)? If that’s the case, the household shouldn’t have received a premium tax credit at all if they kept you on the family policy, since your income pushed the household over the upper cap for subsidy eligibility (your parents probably would have been eligible for a subsidy — or possibly Medicaid — if the policy had just covered them, or any other siblings… Read more »

Mohammed Hussain
Guest
Mohammed Hussain

I really appreciate you taking the time to help out and explain things to people who need it the most.

We are a family of 5, all of us were on it. Technically, the combined total income of all 5 was 116K, so below the 120K of 400% for a family of 5. Shouldnt that make a difference?

Last auestion, if i was 26 (2018), was I eligible to be on the family insurance or was i too old?

Again, i am incredibly thankful for you.

Laurie
Guest
Laurie

I recieved a withdrawl from my pension, raising my income level. I had medical bills to take care of, and still do with this money I received. Now I have lost my job due to the worldwide virus. Will I still be penalized to pay back the entire amount??

Tom
Guest
Tom

Hi – our income exceeded projections by about $15,000 in 2019. We do still qualify for a subsidy but I will need to repay a small amount. My question is in regard to the fact that we had qualified for a zero deductible health plan but now I believe this would not be the case at higher income. Will we have to pay back an amount equal to what the deductible would have been if calculated at the correct income?

Louise Norris
Editor

No. Cost-sharing reductions (CSR) do not get reconciled on tax returns. There is no provision requiring people to pay back anything in regards to cost-sharing reductions they received during the year, regardless of whether their actual income for the year ends up above the cutoff for CSR eligibility.

L S
Guest
L S

great info! Our question: self-employed new business that hasn’t made any income yet. We got thrown to medicaid for 2020. We were on track to make income this year but the current economy likely will nix that. If we find some other way to make money this year, under what $ would we have to pay back Medicaid premium? Household of 2, both in our business.

Louise Norris
Editor

They don’t require you to pay back anything for Medicaid if your annual income ends up above the Medicaid eligibility threshold. If and when your income bumps up again, you can contact the state Medicaid office to let them know. If your income is above the Medicaid threshold, you’ll then qualify for a special enrollment period to purchase a plan in the exchange, triggered by your loss of Medicaid eligibility. But you won’t have to pay back anything for the time while you were covered by Medicaid. Best wishes for success with your business!

L S
Guest
L S

Thank you. I guess what I need to know is that magic date & number…”Medicaid eligibility” level, given that we have incurred business deductions not yet taken due to no sales that would reduce business income variably/ annually before we even see a dime of personal income. If you mean 100-400% poverty level, we could be in & out of that range month to month so indeed, would need to wait to see the whole year’s picture. So can we be penalized by waiting? The ACA plans have huge deductibles even with PTC that our medical situation would cost us… Read more »

Louise Norris
Editor

CSR is still available. You can get an idea of how those plans work by using the plan browsing tool for your state’s exchange. You can enter different income levels and see how the available silver plans change. I assume you’re in a state that’s expanded Medicaid, since you mentioned that you’d qualified for Medicaid. So if you enter an income equal to a little more than 138% of the poverty level (but not more than 150%) you’ll see the plans with the strongest CSR benefits. They are much less strong at 250% of the poverty level, which is where… Read more »

Aarika
Guest
Aarika

I was self-employed for the first 8 months of 2019, but only earned $1500/mo from my business income. I decided to become an “employee” and close my business in August 2019. When I received health coverage with my employer I informed Marketplace and cancelled coverage. Then I got married October 19th. I Just started working on my taxes last night and the software I’m using informed me that I have to pay back the almost $7000 in subsidies because of my husbands income during the time we weren’t married or living together. How is THAT even possible? I wasn’t even… Read more »

Louise Norris
Guest

Aarika,
It’s possible that you might be able to repay less, although we strongly recommend that you consult with a tax adviser who can help you with the details of your specific situation. But the IRS publication about the premium tax credit does have instructions on how to use an alternate calculation for situations like yours (ie, receiving premium tax credits as a single person, but getting married mid-year and filing a join tax return): https://www.irs.gov/pub/irs-pdf/p974.pdf (see page 37, and then pages 43-45)

Oren
Guest
Oren

I AM $401 over the the poverty level on agi and owe $15,000 is there any tolerance or suggestion?

Louise Norris
Editor

We strongly recommend that you reach out to a tax adviser to see if there’s anything that can be done to get your ACA-specific MAGI into the subsidy-eligible range. But one solution that might work is IRA contributions. If you haven’t yet contributed the maximum allowed amount to a traditional IRA, you still have until April 15 to make those contributions, and they do lower your MAGI under ACA rules. HSA contributions can also be made up until April 15 and they also lower the ACA-specific MAGI, although they can only be made if you had an HSA-qualified health plan… Read more »

Guest 22
Guest
Guest 22

I believe that the IRS has confirmed that July 15 will also be the new deadline for making IRA contributions for the 2019 tax year.

Louise Norris
Editor

Yes, they have. They are also allowing HSA contributions for 2019 to be made up until July 15 this year: https://www.healthinsurance.org/glossary/health-savings-account/#contributions

Guest 1
Guest
Guest 1

I had the UHC Essential Community plan for 7 months while I was a substitute teacher and my days working were inconsistent. During my time on the plan I exceeded the amount of money by $4,000 to qualify. I canceled the plan and I have since gotten a full time job which made my year end salay $57,000. What is the subsidy for the Essential Community Plan and will I owe all of it back?

Louise Norris
Editor

The Essential Plan in New York isn’t the same thing as a subsidized qualified health plan. They don’t send out a 1095-A for people enrolled in the Essential Plan, as there’s no premium tax credit to reconcile (in this regard, it functions more like Medicaid). So you shouldn’t have to pay back anything if your coverage during the year was only through the Essential Plan and then your employer’s plan (ie, assuming you didn’t switch to a subsidized qualified health plan in between). Here’s more from New York State of Health: https://info.nystateofhealth.ny.gov/sites/default/files/Tax%20Credits%2C%201095A%2C%201095B%20Webinar%20Slides.pdf

GTS
Guest
GTS

21 yr old, not a dependent of anyone, worked all of 2018 & had ACA premium subsidy for 2018. For 2019 ACA, same job & utilized 2018’s income to estimate 2019 income, which again qualified me for ACA premium subsidy. Took a couple months off work in early 2019 to study for test #1 (of 4) of GED — had savings to pay expenses while off work. Initially planned to go back to work after first test. After first test, decided to focus fulltime on studying for test #2, then go back to work. Rinse & repeat for tests 3… Read more »

Louise Norris
Editor

Congratulations on successfully completing all of your exams, and on your new job! The ACA’s premium tax credit is refundable (ie, they’ll send you whatever excess amount you’re owed, even if you don’t have to pay taxes), but with an income of $700, your premium tax credit amount would have been reduced to $0 during the tax filing process. As you noted, they won’t make you pay back the tax credit that was paid on your behalf, but there shouldn’t be any excess amount stemming from your health insurance. My area of expertise is health insurance, not taxes, so take… Read more »

Ryan
Guest
Ryan

Good afternoon. When filing my 2020 taxes I discovered that I owed all of my premiums roughly $9100. I normally do fall into the 400% poverty tax bracket but after loosing my job in 2018 and my wife not working after giving birth to our son, we had no choice in 2019 but to take an early 401k withdrawal of $23k to pay our student loans, vehicle loans, mortgage, and all other living expenses. Now bc of this, our household income was about $18,665 higher than I originally placed on my application. I have no idea how I’m able to… Read more »

Christine
Guest
Christine

Does the stimulus check have to be included as a change to your yearly income?

Louise Norris
Editor

No, the one-time stimulus check is tax-free and does not get added to your income for determining your subsidy or Medicaid eligibility. But unemployment benefits, including the extra $600/week provided by the CARES Act, are counted as income when premium subsidy amounts are calculated (note that the $600/week is NOT counted for Medicaid eligibility, however). Here’s more about all of this: https://healthlaw.org/congress-stimulus-package-and-its-impact-on-magi/

Diane
Guest
Diane

I was on the Healthcare plan for the last 3 years but now I have cancel it because I am eligible for Medicare. I cancel in October 2019. My question is can I make more income now since I am off of the healthcare plan in 2020 and future years. I like to take money out of my 401K if possible.

Josh Schultz
Guest
Josh Schultz

It sounds like your marketplace coverage ended last year, so this year’s income won’t impact what you get in terms of subsidies through the marketplace. It will however have an impact what you pay for Medicare Part B and D in future years. The income limits and information about income-related premiums are available here: https://www.medicareresources.org/medicare-eligibility-and-enrollment/what-is-the-income-related-monthly-adjusted-amount-irmaa/

Josh Schultz
Guest
Josh Schultz

Because your marketplace coverage ended last year, changes impacting your income this year won’t put you at risk of repaying your marketplace subsidy. Income changes will, however, impact what you pay in future years for Part B and D coverage under Medicare. More information on that is here: https://www.medicareresources.org/medicare-eligibility-and-enrollment/what-is-the-income-related-monthly-adjusted-amount-irmaa/

Lea
Guest
Lea

Hi,

I went over the 400% poverty line because I had a change in employment. Is it too late to try to contribute to my 401K so I lower my MAGI? I still haven’t done my 2019 taxes yet.

Thanks.

Louise Norris
Guest

Lea, You will definitely want to reach out to a certified tax adviser for help. But my understanding is that 401(k) contributions have to be made by the end of the tax year (so Dec 31, 2019, for 2019 contributions). The IRS did extend the deadlines for contributions to HSAs and IRAs, however: https://www.irs.gov/newsroom/filing-and-payment-deadlines-questions-and-answers So if you had HSA-eligible health coverage in 2019, or if you haven’t yet contributed to a traditional IRA for 2019, those are options that might work, and they do both reduce your MAGI for subsidy-eligibility determinations: https://www.healthinsurance.org/faqs/with-my-income-im-barely-over-the-eligibility-limit-for-a-premium-subsidy-is-there-anything-i-can-do-to-lower-my-income-so-i-become-eligible/ Note that there are income limits that are… Read more »

Kathy
Guest
Kathy

My son, 29, has BCBS through ACA Marketplace. He is getting a small subsidy but recently lost his job so has no income now. He is afraid to report it for fears of being dropped from his insurance. I told him his premium should go down but I didn’t think they would drop him. Would they? He has money saved to pay the premium, but not alot for anything else if he doesn’t get it lowered.

Louise Norris
Editor

Kathy, There are a few factors to take into consideration here: 1) His insurance plan cannot drop him due to a change in income. But his subsidy would end if the income change puts his projected income for the year below the poverty level (or below 138% of the poverty level if he’s in a state that has expanded Medicaid, which is the majority of the states). 2) If his total income for the year (including what he earned earlier this year) still puts him in the subsidy-eligible range (ie, at least the poverty level in a state that has… Read more »

Louise Lipert
Guest
Louise Lipert

After completing my 2019 Taxes, it showed that I have to re-pay the tax premium credit I received, as my income went above 400% (by 1%)! I sent this information onto the marketplace and informed them I will be choosing a new plan. I included my 2019 1040 and Form 8962. Then yesterday, I got a call from the marketplace saying my tax credit has been approved for 2020. I called back to confirm and they said it is true. I don’t understand how this can be – for 2019, I need to re-pay the credit and in 2020 with… Read more »

Louise Norris
Editor

Hi Louise, Just in case it’s an option for you, I wanted to make sure you know that contributions to a pre-tax retirement account (and/or an HSA, if your health plan was HSA-qualified) will reduce your ACA-specific MAGI and might make it so you don’t have to repay the subsidy that was paid on your behalf in 2019 (and you still have until July 15 to make those contributions, since the tax deadline was extended this year): https://www.healthinsurance.org/faqs/with-my-income-im-barely-over-the-eligibility-limit-for-a-premium-subsidy-is-there-anything-i-can-do-to-lower-my-income-so-i-become-eligible/ But even if there’s nothing you can do to get your ACA-specific MAGI from 2019 into the subsidy-eligible range, it’s possible that… Read more »

John Smith
Guest
John Smith

My wife and I lost our jobs in May 2020. We have no insurance as of 6/1/20. For family of 4, the income limit is $41,200 in Connecticut. We had insurance from my job until May 31, 2020 and made around $85000 ( combined income). Now, we are applying for a state insurance as of 7/1/2020 and we have no jobs. When they calculate our income, are they going to use the income after 7/1/2020? Our state insurance will start on 7/1/2020

Louise Norris
Editor

John, If you’re applying for Medicaid, they can calculate your eligibility based on your current monthly income, even if it’s $0. Connecticut expanded Medicaid under the ACA, which means coverage for adults in a family of four would be available with an annual income of up to about $36,000 this year (kids are eligible even with a higher household income). But if you’re applying for a private plan in the marketplace (Access Health CT), your subsidy eligibility is going to be based on your total household income for the year (it’s an ACA-specific calculation of MAGI, described here: https://www.healthinsurance.org/glossary/modified-adjusted-gross-income-magi/ ).… Read more »

Maryellen
Guest
Maryellen

A friend in Texas I helped get signed up for the ACA. I’m an independent woodworker. I evidently didn’t provide the right proof of income to the government and they dropped my subsidy. I had given my insurance company permission to debit my account and $800 suddenly disappeared! I can’t pay my mortgage without that money. I’m going to contact the ACA office and my insurance, but I’d like advice about the best way to get my money back. I know it can be a difficult and lengthy process to deal with the government and insurance company, but can’t wait… Read more »

Louise Norris
Editor

I’m sorry you’re in this situation. We have some general information here about resolving issues with the marketplace and your insurance plan: https://www.healthinsurance.org/faqs/who-can-help-if-i-have-a-problem-with-my-aca-compliant-coverage-or-exchange-enrollment/ You’ll probably want to start with the exchange (Texas uses HealthCare.gov; the call center number is 1-800-318-2596). You can ask them to escalate the situation if they don’t seem able to help you quickly from the beginning. Make sure you keep careful notes about who helps you, an applicable incident number, etc. You may or may not have to contact your insurance company as well.

Mike
Guest
Mike

Since Louise has graciously continued to answer questions on this post, I’ll see if she can help with mine. My 22-year old Daughter in NC obtained a subsidized Silver plan for 2020 based on her plan to graduate from college in May and obtain a job as a public school teacher by August . For income verification, she provided the requested letter stating that she would be graduating and then working the last five months of the year with a projected income of $14,600 over that time. She was not going to be our tax dependent this year and we… Read more »

Louise Norris
Editor

Mike, This is a difficult situation, for sure. It’s true that NC has not expanded Medicaid, which means there is no financial assistance available for an adult earning less than the poverty level, if they don’t qualify under one of Medicaid’s other eligibility categories (disabled, pregnant, etc.). When her premium subsidy is reconciled next spring (on her 2020 tax return), the IRS will not, as a general rule, make her repay the subsidy if her actual income ends up being below the poverty level. I explain that in more detail here: https://www.healthinsurance.org/faqs/if-my-income-is-less-than-expected-this-year-i-might-be-eligible-for-medicaid-what-can-i-do-during-open-enrollment-to-cover-my-bases/ But Publication 974 (see the bottom of page… Read more »

Mike
Guest
Mike

Thanks, Louise. I did read through the article you linked and agree that the goverment does not reclaim the premium subsidy for those below 100% of the poverty level. Several other sources confirmed this, making it difficult to see the incentive to report the income reduction unless not doing so will interefere with next year’s enrollment process. (Not that any advisor would ever recommend that path.) We’re also investigating the university insurance option–good suggestion. Thank you again for taking the time to provide such a detailed reply.

Ann
Guest
Ann

I anticipated earning more than I indicated on my application. I was put into a Silver plan. Currently, my only income is SS Retirement and the yearly total would most likely put me in the Medicaid range. I have a few questions, 1) Would I have to pay any of my subsidy back; 2) Will I immediately be terminated upon filing my Tax Return; 3) Will I be eligible for Medicaid; and 4) Do you know if it is accurate that if you are on Medicaid, and subsequently die, Medicaid will put a lien on your Estate dollar for dollar… Read more »

Louise Norris
Editor

Ann, We recommend that you seek advice from a tax adviser who can help with the details of your specific situation. But here’s some general information that might help: 1) If you’re enrolled in a marketplace plan with premium subsidies and you end the year with income that would have made you Medicaid-eligible, the IRS will generally not make you repay the subsidy that was paid on your behalf. That’s explained in more detail here: https://www.healthinsurance.org/faqs/if-my-income-is-less-than-expected-this-year-i-might-be-eligible-for-medicaid-what-can-i-do-during-open-enrollment-to-cover-my-bases/ 2) No, your health plan would not be terminated when you file your tax return, and your premium subsidy should not change either. The… Read more »

Jana Jesmer
Guest
Jana Jesmer

I understand that since I overestimated my income, I must repay the subsidies allowed. Do I have to pay 100% back?

Louise Norris
Editor

It depends on your income. If you earned more than 400% of the poverty level, you’ll have to pay back the entire premium subsidy that was paid on your behalf. But if your income was less than 400% of the poverty level, the amount you have to pay back is capped, and the caps vary depending on your income. The details are shown in Table 5 of the instructions for Form 8962: https://www.irs.gov/pub/irs-pdf/i8962.pdf (Table 5 is on page 16 of those instructions). So for example, if you’re a single person and you earned $30,000 last year, the amount of excess… Read more »

Rob
Guest
Rob

Hi, My aunt received inheritance this past year reported to her on a 1099-R. This was a sizeable amount and put her over the 400% poverty limit so she now must repay the entire premium tax credit of over $10,000. Is there any breaks or anything that can be done because it was an inheritance?

Louise Norris
Editor

It sounds like the inheritance was from a pre-tax retirement plan, since it was reported on a 1099-R and the IRS is saying that she has to repay her premium tax credit (in other words, they’re saying it was taxable income). Inheritances generally aren’t taxable, but that’s not the case for inherited retirement accounts in which the money was originally contributed pre-tax. Here’s more about that: https://www.alllaw.com/articles/nolo/wills-trusts/must-pay-income-tax-inherited-money.html Unfortunately, there’s no exception to the 400% of FPL cap on premium tax credit eligibility. If her taxable income goes over that limit, all of the premium tax credit has to be repaid.… Read more »

Joe
Guest
Joe

I had been receiving $1700/month tax credit through the ACA. I got a better job with benefits and cancelled my ACA on July 14th. I will now exceed the 400% limit. Do you know if I will need to pay back the full amount for ACA coverage in July, or if it will be prorated? Thanks for your help.

Louise Norris
Editor

Unfortunately, if your income exceeds 400% of the poverty level this year, you’re going to have to pay back the entire premium tax credit that was paid on your behalf from January through July. The rule that prohibits premium tax credits for anyone with income above 400% of the poverty level applies regardless of whether the income is earned throughout the year or all in one chunk at the end of the year or somewhere in between. So you’ll want to plan ahead for this, as you might be facing a significant tax bill next spring. “Income” is based on… Read more »

Joe
Guest
Joe

Thanks for your reply. I might not have been very clear with my question: I do understand that I will need to pay back the premium through June, but I am wondering if July will be prorated as I canceled on the 14th. I appreciate your response.

Louise Norris
Editor

Thanks for the clarification. As a general rule, pro-rated refunds are not issued and coverage would be terminated July 31 in that case. But we have heard of some variation on this. You’ll need to look at the termination of coverage letter that you receive from your insurer and the marketplace to be sure.

Kelly Doyle
Guest
Kelly Doyle

We actually earned a small enough income to qualify. Problem is, in July my husband was informed by a previous employer that he could cash out some stock. We did this and our income then showed too high, so now they say we have to repay $28,000!!! I had called and questioned the rep at Marketplace and in July and was told not to worry about it, that there was a cap of like $1200. I most certainly would have cancelled my insurance in July 2019 and saved over $12,000 owing to IRS had I been properly informed. Guess I… Read more »

Louise Norris
Editor

I’m sorry you’re in this situation! You’ve probably figured it out by now, but the cap the rep was talking about only applies for households that end up with an income that doesn’t exceed 400% of the poverty level. If you go over that amount, there’s no cap. So the cap would apply for a household that, for example, projected an income of 300% of the poverty level and then ended up with an income of 380% of the poverty level. For a married filing jointly household, the excess subsidy repayment would have been capped at $2,650 (see page 16,… Read more »

Sky
Guest
Sky

Hi Louise, Thanks for your article. I wish to be prepared for my 2020 income tax filing next year. I am new to collecting the unemployment compensation. Per Covered California Health Insurance website, the extra $600 taxable income per week PUC is Not counted for determining one’s eligibility for Medi-Cal in California. If so, Will there be any subsidies expected to be paid back in either scenarios? What tax forms should I be using (a 2019 sample forms is good enough for now)? Scenario 1. My total income for the year (2020) ExceedS 400% of the poverty level, Scenario 2.… Read more »

Louise Norris
Editor

Sky, We always recommend that people contact a tax professional if they have questions about their specific tax situation. But as general background information, the extra $600/week in federal unemployment benefits IS counted when determining eligibility for premium subsidies in the marketplace, but IS NOT counted when determining eligibility for Medicaid (Medi-Cal in California). Here’s more about this: https://healthlaw.org/congress-stimulus-package-and-its-impact-on-magi/ If a person is enrolled in a private qualified health plan through the marketplace and receiving premium subsidies and then ends up with an income above 400% of the poverty level, they will have to pay back the entire subsidy amount.… Read more »

Sky
Guest
Sky

Louise, Thank you so much for the clear and very helpful response. I’ve learned a lot from you on the subject.

Best,
Sky

Anita
Guest
Anita

I receive a monthly tax credit for marketplace insurance for me, my husband and son who just turned 20, he is the oldest of our children. We are a household of 6. He did not attend college in 2020 and lives with us and we provide more than half of his living expenses. He files his own tax return and will likely go over $12,000 with the unemployment and the federal unemployment($600 per week) due to the pandemic. I was told I can not claim him as a dependent on our taxes. Will I have to pay back all of… Read more »

Louise Norris
Editor

Anita, You should speak with a tax professional for specific advice pertaining to your family’s situation. But the instructions for Form 8962 (use to reconciled premium tax credits) might be helpful in terms of understanding how this is handled: https://www.irs.gov/pub/irs-pdf/i8962.pdf Since you can’t claim your son as a tax dependent, you’ll be considered two separate tax households when you each file your returns next spring. The IRS addresses this on page 18 of the instructions for Form 8962. Basically, the premium tax credit gets allocated between the two tax returns, and the filers can choose how to allocate it. So… Read more »

Anita
Guest
Anita

Thanks, so for 2021, I should just create his own marketplace account and enroll him in his own healthcare or do it the same way as 2020? Also, it states your child must be under the age of 19 at the end of the year. Does that mean 19 ? My second son is turning 18 this month and I will be fine with him as a defendant for 2020 , but not sure for 2021.

Anita
Guest
Anita

Oh, one more question. So if My son gets his own marketplace account in 2021 and qualifies for monthly tax credit and for some reason does not earn the required amount annually which I think is 12,500 does he have to payback the entire subsidy or just based on under the 400% poverty chart for single?

Thanks so much.

Anita
Guest
Anita

Thanks, so for 2021, I should just create his own marketplace account and enroll him in his own healthcare or do it the same way as 2020? Also, it states your child must be under the age of 19 at the end of the year. Does that mean 19 ? My second son is turning 18 this month and I will be fine with him as a defendant for 2020 , but not sure for 2021. Oh, one more question. So if My son gets his own marketplace account in 2021 and qualifies for monthly tax credit and for some… Read more »

Ju ju
Guest
Ju ju

I’m ending Market place healthcare coverage to enroll in a job based plan. What happens if I end up making more than my estimated salary for the year after I have ended
the marketplace plan?

Louise Norris
Editor

If you end up earning more than you projected for 2020, you’ll have to pay back some or all of the premium tax credit that was paid on your behalf. If your total household income for the year (including whatever you earn from your new job) doesn’t exceed 400% of the poverty level, there are caps on how much of the premium tax credit you’d need to repay (see Table 5 in the instructions for Form 8962: https://www.irs.gov/pub/irs-pdf/i8962.pdf ) But if your income ends up going over 400% of the poverty level, you’ll have to repay all the premium tax… Read more »

Chris Koenig
Guest
Chris Koenig

I reported when I signed up for a marketplace plan that i would make $22,000 in 2020. Turns out I will be at around $27,500 because of unemployment $600 benefit payments. Calculator shows that at 231.5% of federal poverty level. what would you assume I will owe back? i am single and only one in household with just that income nothing else to claim. thanks if you have any info for me!

Louise Norris
Editor

Great question! The poverty level (in the continental US) for a single person in 2019 was $12,490, and that’s the number that’s used to determine subsidy eligibility for 2020 coverage. The amount you projected ($22k) put you at 176% of the poverty level, whereas the amount you’re going to end up earning ($27,500) puts you at 220% of the poverty level. This FAQ explains how the math works in terms of how much of your income you’re expected to pay for the benchmark plan at a particular income level: https://www.healthinsurance.org/faqs/is-the-irs-saying-ill-have-to-pay-more-for-my-health-insurance-next-year/ The short story is that your expected contribution at $22k… Read more »

Randy
Guest
Randy

Hi – I am in the rare situation where I paid the full unsubsidized premium for my exchange program (wife and 1 child). I am self employed and my income typically comes in the form of lump sum payments toward the end of the year. In 2019, I expected to received a large payment by December that ultimately was pushed into January of 2020 (due to a legal dispute with the payer). As a result, my income for 2019 fell below the poverty level – something I could not have predicted until the very end of the year. Now I… Read more »

Louise Norris
Editor

Unfortunately, yes. I wish I had a better answer for you, and I’d advise you to consult with a tax adviser to see if there’s any way that your income for 2019 can be adjusted. But if not, you would not be eligible for the premium tax credit. This is explained in the instructions for Form 8962: https://www.irs.gov/pub/irs-pdf/i8962.pdf (on page 2 and page 8). They would allow a premium tax credit if the marketplace had estimated your projected income to be at least 100% of the poverty level and provided you with APTC, even if your income then fell below… Read more »

Randy
Guest
Randy

Thanks for the reply Louise, may be able to boost earned income for year to reach that level – but there is one other wrinkle. I have a NOL from previous year loss, my thought was to qualify for APTC my earned income for the year just has to be over the poverty level – but does the NOL offset MAGI for the purposes of APTC qualification as well – meaning do I have to earn back the entire NOL plus the min poverty level income to qualify. Thanks in advance again for time.