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13 qualifying life events that trigger ACA special enrollment
Outside of open enrollment, a special enrollment period allows you to enroll in an ACA-compliant plan (on or off-exchange) if you experience a qualifying life event.

Latest News & Topics

Latest News & Topics

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Featured
Finalized federal rule reduces total duration of short-term health plans to 4 months
A finalized federal rule will impose new nationwide duration limits on short-term limited duration insurance (STLDI) plans. The rule – which applies to plans sold or issued on or after September 1, 2024 – will limit STLDI plans to three-month terms, and to total duration – including renewals – of no more than four months.
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modified adjusted gross income (MAGI)

What is MAGI or modified adjusted gross income?

healthinsurance.org health insurance glossary

Under the Affordable Care Act (ACA), eligibility for Medicaid, premium tax credits or premium subsidies, and cost-sharing reductions or  is based on modified adjusted gross income (MAGI). But the ACA has its own calculation of MAGI, which differs from MAGI calculations used for other purposes.

The details of the MAGI calculation are outlined here. If you have questions or want guidance about your particular circumstances, consult a tax advisor or other professional.

MAGI starts with adjusted gross income (AGI) from Form 1040, but three things must be added to AGI to get MAGI under the ACA. If applicable, you must add in these amounts:

  • Non-taxable Social Security benefits (this includes Social Security Disability Insurance benefits (SSDI), but Supplemental Security Income (SSI) does not get counted when the ACA-specific MAGI is determined)
  • Tax-exempt interest (typically earned on municipal bonds)
  • Foreign-earned income and housing expenses for Americans living abroad

Calculate Yearly Income

Use this to calculate your household’s estimated yearly income. Consider including your income, your spouse’s income, and that of any tax dependents, all of which are usually counted by the Marketplace. After that, provide information about expenses that may be deducted.
Income
Add different income sources. If an individual gets an income from a source at different times during the year, enter it as multiple income sources.
Expenses
Add student loan interest, alimony, educator expenses, or IRA contribution this person pays, if any. Please note: these expenses are limited by IRS rules.

This calculator is for educational and illustrative purposes only and should not be construed as financial or tax advice. It uses the income and other information you provide. We included categories of income and expenses that the Marketplace commonly (but not always) uses. You should contact a tax advisor or other professional about any specific requirements or concerns.

Calculate

Your Estimated Yearly Income:

Click calculate to see updated yearly income

For Medicaid eligibility, some expenses can be subtracted, including scholarships and grants used for education, and certain American Indian/Native American income.

Income received as a lump sum is counted as income only in the month it’s received when determining eligibility for Medicaid (whereas it would be counted as part of an enrollee’s annual income for determining eligibility for premium subsidies), although there’s an exception for lottery and gambling winnings of $80,000 or more — those amounts can be counted as income spread out across up to 120 months.

If you receive advance premium subsidies (paid to your insurer on your behalf) based on your projected MAGI, the amount has to be reconciled on your tax return based on your actual MAGI for the year. But there’s no after-the-fact reconciliation process for Medicaid or cost-sharing reductions.

In other words, Medicaid and CSR eligibility are determined at the time a person applies for coverage, and the benefits do not have to be repaid if the person’s actual MAGI ends up being different from what they projected.

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