With my income, I’m barely over the eligibility limit for a premium subsidy. Is there anything I can do to lower my income so I become eligible?

Q. With my current income, I am not eligible for a premium subsidy–but I’m just barely over the limit. Is there anything I can do to lower my income as far as the exchange is concerned?

A: Your best bet is to talk with an accountant. They are trained to spot places where you might be missing out on deductions and tax breaks, and the money you spend to hire one will be well spent.

That said, there are some basics to keep in mind. ACA premium subsidies are based on modified adjusted gross income (MAGI), but the calculation for it is specific to the ACA (and different from the general MAGI rules) For most people, ACA-specific MAGI is the same as adjusted gross income, or AGI (from Form 1040). But if you have any tax-exempt Social Security income, tax-exempt interest income, foreign-earned income or housing expenses for Americans living abroad, you have to add those amounts to your AGI in order to get your MAGI.

Reduce your MAGI with a retirement plan, HSA contributions, and self-employed health insurance premiums

You can reduce your MAGI by earning less money, but a lot of people prefer to look for deductions instead. Consider the available deductions on your tax return that are above the line that shows your AGI (this used to be Line 37 on the regular 1040; it’s now Line 7 on the second page). If you’re not already contributing the maximum allowable amount to an individual retirement account (IRA), doing so would lower your MAGI (it has to be a traditional IRA; contributions to a Roth IRA are not tax-deductible). You and your spouse can each contribute to an IRA, further lowering your total household MAGI. Keep in mind that if you also have a retirement plan at work, the amount of deductible contributions you can make to a traditional IRA depends on your income.

[Note that the general MAGI calculations require you to add back traditional IRA contributions, but ACA-specific MAGI rules are different–your deductible traditional IRA contributions do lower your ACA-related MAGI.]

If you have access to an employer-sponsored pre-tax retirement plan like a 401(k), you can contribute to that in order to lower your MAGI. If you’re self-employed, you can set up a self-employed retirement plan. SEP IRA, SIMPLE IRA, or Solo 401(k) are all options –talk with your accountant to see which one will work best for you, keeping in mind that these retirement plans for self-employed people have contribution limits that are potentially much higher than traditional IRAs, making them a good option if you’re trying to reduce your MAGI. Depending on your income, you may also be able to make tax-deductible contributions to a traditional IRA.

If you have an HSA-qualified high-deductible health plan (HDHP), contributing to an HSA (health savings account) will also lower your MAGI. The maximum contribution amount in 2020 is $3,550 if your HSHP covers just yourself, and $7,100 if it also covers at least one other family member. Those contribution limits in 2019 were $3,500 and $7,000, respectively. And although you normally have to make contributions for a given year by the following April 15, the IRS has extended the 2019 HSA contribution deadline to July 15, 2020, due to the COVID-19 pandemic.

Self-employed people can also deduct their health insurance premiums as a means of lowering their MAGI, but it gets a bit complicated if that’s the factor that makes you eligible for a premium subsidy.

Your subsidies might go a long way towards covering the contributions you make to your IRA and HSA

To put all of this in perspective, consider a married couple, each 55 years old, with HSA-qualified health coverage and a combined household income of $80,000. This is well above the MAGI cap for premium subsidy eligibility ($67,640 for a household of two in 2020; based on 400 percent of 2019 federal poverty level numbers). But assuming they have earned income (ie, their income isn’t all from investments and capital gains), they can each contribute up to $7,000 to an IRA for 2020 ($6,000 plus a $1,000 catch-up contribution, since they’re over age 50), and they can contribute up to$7,100 to an HSA. Contributing the maximum amounts would bring their MAGI down to $58,900, which is well within the subsidy-eligible range.

Let’s say this couple lives in Norfolk, Virginia. In 2020, if they just use their $80,000 MAGI, they don’t get any premium subsidies and the cheapest plan available to them in the exchange would cost $1,276/month (this plan is not HSA-eligible; in order to make contributions to an HSA, they’ll need to buy an HSA-qualified plan, the cheapest of which is $1,322/month if they don’t qualify for any premium subsidies).

But if they select the HSA-qualified plan and then contribute a total of $15,000 to their IRAs and HSA, they’ll get their MAGI down to $65,000, and they’ll qualify for $1,171/month in premium subsidies. That’s more than $14,000 in tax credits for the year, which is nearly as much as they contributed to their retirement accounts and HSA in order to become eligible for subsidies. In other words, the tax credits almost fully fund their savings.

To recap, if they end up with a MAGI of $80,000, they’re going to have to pay at least $15,312 in premiums for their health insurance, which works out to 19 percent of their income. That will leave them with a little over $65,000 left over to cover all of their other expenses for the year, including out-of-pocket medical costs (the $15,312 amount is just for the premiums on the cheapest plan available to them, which has an $8,150 out-of-pocket maximum for each of them). And they won’t have anything saved for retirement at the end of the year.

But by contributing a total of $15,000 to their IRAs and HSA, they can enroll in an HSA qualified plan for just $151/month in premiums after the subsidy is applied. They’ll still have $65,000 to work with as far as income during the year, and they’ll end the year with $15,000 spread across their retirement accounts and HSA (of course, the amount in their HSA will be reduced if they end up needing to withdraw money to pay for out-of-pocket medical costs, but they would have had to pay that money anyway, using after-tax funds, if they hadn’t contributed to their HSA).

To be clear, this scenario won’t work out the same way in all areas. If this couple lived in Phoenix and contributed enough to their retirement accounts and HSA to get their MAGI down to $65,000, they’d still qualify for a subsidy ($867/month), but they’d have to pay $390/month for the cheapest HSA-qualified plan available in the exchange. But the subsidy would still save them more than $10,000 over the course of the year, and if they’d kept their MAGI at $80,000, the cheapest plan they could get would have been $1,171/month.

Younger applicants get smaller subsidies, but the general concept remains the same: Contributing to a retirement account and/or HSA will result in lower health insurance premiums if the contribution amounts are enough to get your MAGI into the subsidy-eligible range. If our couple in Norfolk is 35 instead of 55, their subsidy amount would be $402/month and they’d have to pay $322/month for the cheapest HSA-qualified plan. But if they skipped the retirement and HSA contributions and kept their MAGI at $80,000, they wouldn’t get any subsidy at all, and would have to pay $700/month for the cheapest plan available in the exchange.

You have until April to make the prior year’s HSA or IRA contributions (for 2019 contributions, this has been extended until July 2020)

Another thing to keep in mind about HSA and IRA contributions: You can deposit money in those accounts at any time during the year or even in the first few months of the next year, as long as you make your contributions before the tax filing deadline. So if you enroll in a plan through the exchange for 2020 and don’t qualify for subsidies, you have until April 15, 2021 to contribute to an IRA and/or an HSA and reduce your MAGI for 2020 (premium subsidies are reconciled on your tax return, so that’s when you’d be sorting out the details with the IRS in terms of the exact amount of premium subsidy you were supposed to receive during the year).

For the 2019 tax year, the filing deadline has been extended until July 15, 2020, as a result of the COVID-19 pandemic. And the deadlines to make 2019 contributions to your HSA or IRA have also been extended until July 15, 2020.

Other deductions and their impact on MAGI

There are other deductions will also serve to reduce your MAGI, since they reduce your AGI and don’t have to be added back to calculate the ACA-specific MAGI. These include things like alimony payments (from settlements executed prior to 2019; alimony from a settlement executed in 2019 or later does not count as income), student loan interest, tuition and fees, moving expenses, and the deductible portion of self-employment taxes. The deductions that reduce AGI are found on lines 23 to 35 of Schedule 1 for Form 1040.

Itemized deductions like mortgage interest, charitable contributions, medical expenses, etc. (or the standard deduction instead) are subtracted after AGI is calculated. So they do not lower AGI and thus do not have an impact on MAGI.

What if you need to increase your MAGI to qualify for subsidies?

On the other end of the spectrum, people living in states that have not expanded Medicaid may need to increase their MAGI in order to qualify for a subsidy, since Medicaid is available in those states on a very limited basis, and premium subsidies in the exchanges are not available to households with incomes below 100 percent of federal poverty level (FPL).

Navigators in those states recommend that residents keep track of every penny they earn, even from infrequent jobs. Some residents have been able to cobble together enough income from a variety of sources to get above 100 percent of poverty, even though the income from their primary job was too low to qualify for subsidies. Things like babysitting, selling extra garden produce, handyman work, and utilizing craft fairs to market a hobby like knitting or woodworking can sometimes make the difference.

But new rules finalized in 2018 require applicants to provide proof of their income if they attest to an income over the poverty level and existing federal data shows that the applicant has income below the poverty level. So people who are scrambling to attain an income of at least the poverty level need to keep careful records of their income sources so that they can provide proof of income if the exchange requests it.


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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

Find affordable health plans

Since 2008, we’ve helped more than 16 million people.

(Step 1 of 2)

Related terms

FPL

high-deductible health plan (HDHP)

premium subsidies

Related articles

18

avatar
6 Comment threads
12 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
10 Comment authors
Louise NorrisdmonnigWilliam BauerWilliam Ronald BauerDaniel Recent comment authors
newest oldest most voted
Brian T
Guest
Brian T

This is a great write-up. Very clear. Thanks so much.

Louise Norris
Editor

Thank you! I’m glad it was helpful!

sfrye
Guest
sfrye

In the example you gave (couple making $80K), if they were self-employed, would they also be able to deduct their health insurance premiums from their ACA MAGI? Also, is there any combined limit based on income when taking ACA MAGI deductions? For example, If I’m self employed (married) and making $14,000 (the rest of my income coming from pensions, savings, etc.) can I take the $14,000 deduction (2020) for IRA contributions AND health insurance premium deductions (since combined would be greater then my self employment income)?

Louise Norris
Editor

Yes, the health insurance deduction is available to self-employed people, and it reduces MAGI for subsidy-eligibility determination. But that can be a bit of a circular question, since the lower the MAGI is, the higher the subsidy will be… which results in a smaller portion of the premiums being deductible (you can only deduct the after-subsidy portion of the premiums). Here’s more about how that works: https://www.healthinsurance.org/faqs/my-premium-subsidy-is-dependent-on-my-agi-but-im-self-employed-so-my-agi-is-dependent-on-my-premium-help/ Both deductions — IRA contributions and the self-employed health insurance deduction — are limited to no more than your earned income for the year. So you would not be able to use them… Read more »

Sally
Guest
Sally

I am trying to lower my AGI for my IBR student loan payments to be as low as possible. I was told my income was too high to deduct IRA contributions. My gross pay was 79K and expect that to rise next year to 100K gross. It seems even if I contribute more to my workplace 401K or separate IRA or Roth, I have no way of lowering my AGI for future help. Is my only option to put as much into my HSA, which only would lower so much? Appreciate any insight. Currently at 300K in student loan debt… Read more »

Louise Norris
Editor

As is always the case with questions related to a person’s specific tax situation, we advise you to consult with a tax professional who can take a look at all the variables affecting your situation. But just a few things to keep in mind: The above article pertains to ACA-specific MAGI. The calculation for MAGI under the ACA isn’t the same as the non-ACA MAGI calculations that people are accustomed to, and it’s also not the same as AGI for some people. I’m not familiar with the rules for IBR student loan repayments, but if they use AGI it could… Read more »

Ben
Guest
Ben

Could you please clarify ROTH IRA withdrawal during 2020. This will not be considered income when calculating eligibility for Marketplace Healthcare?

Maurie Backman
Guest
Maurie Backman

Roth IRA withdrawals do not count as income for Marketplace purposes.

William Ronald Bauer
Guest
William Ronald Bauer

You can only have your traditional IRA reduce your AGI with earned income.

Louise Norris
Editor

It’s correct that IRA contributions have to be traditional (as opposed to ROTH) in order to reduce ACA-specific MAGI. And you do need earned income in order to contribute to an IRA. As noted above, ROTH IRA withdrawals are not considered income, because you already paid taxes on that money before you contributed it to the IRA. Similarly, ROTH IRA contributions do not affect AGI (or ACA-specific MAGI), because the contributions are not tax-deductible.

William Ronald Bauer
Guest
William Ronald Bauer

Thank you for this article. I have a part time job with my social security. From what I understand also pre-tax contributions to a 401K also lower your MAGI for the ACA APTC up to what is allowable for the year. My employer allows me to put 90% of my earnings in. Is this correct?.

Louise Norris
Editor

Pre-tax contributions to a 401(k) are subtracted from your wages and the lower wage amount is shown on your W-2. So yes, those contributions will lower your AGI and thus lower your ACA-specific MAGI. People don’t deduct them on their tax returns the way they do with traditional IRAs, but the overall effect is still the same — pre-tax retirement account contributions will result in a lower ACA-specific MAGI. You mentioned that you’re part-time, so I assume your employer doesn’t also offer you health insurance? But if they do, that would disqualify you from a premium subsidy if the employer’s… Read more »

William Bauer
Guest
William Bauer

Thank you again! I need 30 hours or more for health insurance coverage from my employer per week. I only work 10 to 15 hours a week. I am assuming the 1200 dollar Cares Act stimulus is not going to be added into the calculation of the ACA-specific MAGI. I know it is a tax credit and not taxable.

Meredith
Guest
Meredith

As a married couple filing jointly in 2019, we paid the full amount for health insurance on the Massachusetts marketplace. We now have an extension through July 15 to make IRA contributions to lower our AGI and file taxes. Assuming that we can get the AGI to an amount that would qualify for a subsidy, where does that money come from? Will it be in the form of a payment from the health insurance company, the state or the federal govt.?

Daniel
Guest
Daniel

Since you paid full price in 2019 (no subsidy), but in 2020 you made a contribution to your 2019 IRA which now allowed you to qualify for a 2019 federal tax subsidy, that money that the federal government would have subsidized your health care for 2019 will be “refunded” to you in the form of a refundable tax credit. This is given to you when you file your 2019 federal taxes in 2020. I.e. lets say you spend 10k in 2019 on health premiums, but now that you lowered your 2019 income to qualify for what would have been 6k… Read more »

Louise Norris
Editor

Daniel’s reply below is correct. The money will come from the IRS, and will either be issued to you as a tax refund, or used to offset income tax that you would otherwise have owed to the IRS based on your tax return.

dmonnig
Guest
dmonnig

My understanding is if you need to increase your income to qualify in a state that did not expand Medicaid (ex. Texas), you can roll money from a traditional 401K to.a Roth IRA and that would count as income. Ex. I have 10K in income, if I need to increase my income to 30K, I can roll 20K from my 401K to a Roth IRA and pay that taxes on that. That would take me to 30K in income for the year. I have read other articles on this, can you confirm?

Louise Norris
Editor

Money that you convert from a pre-tax retirement account to a Roth account will be added to your taxable income in the year you make the conversion, so this will increase your AGI and your ACA-specific MAGI. But you’ll want to make sure you consult with a tax adviser who can help you understand all of the tax implications, as there’s more to it than just an increased AGI: https://www.investopedia.com/articles/retirement/08/convert-401k-roth.asp