Advance Payments of the Premium Tax Credit APTC
How to get & qualify for Subsidies
Introduction to Subsidies – Premium Tax Credit
To make this all “simple” just use our quote engine and/or watch our video on using the quote engine.
what is MAGI Income or does this or that count as income.
How do you get the premium tax credit?
Check out our quote engine, to get a preliminary indication of the amount of subsidies you’ll qualify for. There is no extra charge for our services,
In a lot of ways subsidies are hocus pocus smoke & mirrors as you have to file Form 8962, Premium Tax Credit, with your tax return at the end of the year. So, at the end of the year if you make too much $$$ you might have to give it back. If you make less, you get money back on your taxes.
Failing to file your tax return will prevent you from receiving advance credit payments in future years and can cause MAJOR PROBLEMS and coverage CANCELLATION!
The premium tax credit is refundable so taxpayers who have little or no income tax liability can still benefit. The credit also can be paid in advance to a taxpayer’s insurance company to help cover the cost of premiums. IRS Website on “The Basics“
Links & Resources
- FAQ’s on IRS website
- Covered CA Brochure
- KFF Foundation FAQ’s
- irs.gov/affordable-care-act-tax-provisions
- VIDEO Introduction to Individual Plans for those coming from Employer Group Plans
- Pros – Cons – Complicated FAQ’s Research on staying with under 65 plan? Covered CA? vs Medicare
- Simple calculator to figure out your subsidy
Calculate your Covered CA MAGI Income
take #Line8b 11 Adjusted Gross income then add line 2a, 6a & 8 (Foreign Income)
- 1040 IRS Annual Tax Form
- Schedule 1 Additional Income & Adjustments to Lower your MAGI Income
- Calculate - Estimate your Taxes
- Steve's Video on MAGI Income
- Get instant quotes, subsidy calculation and coverages
- NO ASSET TEST for MAGI based subsidies in Covered CA or MAGI Medi Cal Qualification. VIDEO
- Nor is there a lien against your estate for Covered CA or MAGI Medi Cal
All our plans are Guaranteed Issue with No Pre X Clause
Quote & Subsidy Calculation
There is No charge for our complementary services
Watch our 10 minute VIDEO
that explains everything about getting a quote
- Our Quote Engine Takes all the complexity out of using pencil and paper to figure out the premiums per the Obamacare/ACA rules under CFR §1.36B-3 *
- Get more detail on the Individual & Family Carriers available in CA
Federal Poverty Level &
Program Chart
Medi-Cal? Covered CA Subsidies? Enhanced Silver?
Steve Shorr VIDEO on subsidies
Health Care Reform
CMS VIDEO explains the advance premium tax credit and the different ways in which you can apply it to lower the cost of insurance for you and your family.
#COVID19 Bill
The American Rescue Plan Act ARPA
2021 Federal Stimulus Package
March 2021
VIDEO Introduction to ARPA by Steve
- BIG problems with premiums for 2023 if ARPA isn’t continued! Learn More
- health payer intelligence.com/hhs-cms-extend-american-rescue-plan-funding-for-hcbs-another-year
- I don’t know if or how this might apply to Covered CA subsidies.
- There might – will be big increases in 2022 when subsidies are lost, especially the unemployment benefit.
- Covered California Leader Urges Renewal of Enhanced Federal Aid for Health Premiums CA Health Line.org
- Pressure to extend subsidies ARPA Fierce Health News 5.24.2022
- Healthcare spending could drop $11.4B next year if ACA premium subsidies expire Health Care Dive.com 5.26.2022
- health payer intelligence.com/hhs-cms-extend-american-rescue-plan-funding-for-hcbs-another-year
- Covered California’s Insurance Deals Range From ‘No-Brainer’ to Sticker Shock
- The Coronavirus bill represents the biggest expansion of Federal Help – Subsidies, since ACA/Health Reform/Obamacare started in 2010!
- Use our Quote Subsidy Calculator Engine, to see how ARPA works for you.
- There are way more subsidies and there is no upper income limit chart (FPL) for 2021 and 2022.
ARPA Provides:
- Those enrolled in Covered California health plans will not have to pay more than 8.5% of their household income for the second lowest cost silver plan – Get Quotes
- If you are not in Covered CA, there is a special enrollment period to apply. If you stay with the same insurance company, your deductibles & co pays will transfer over!
- Any person in 2021 who received unemployment insurance for one week or more, and their total income qualifies for coverage through Covered California, will receive federal premium tax credit available for 138% of FPL Silver 94? for the duration of the Public Health Emergency in 2021.
- In California, individuals making between 138 percent and 150 percent of the federal poverty level — between $17,776 and $19,140 per year — will see their already-low premiums eliminated. San Diego Union * Covered CA FAQ for Brokers *
- 100% federal premium subsidy for COBRA coverage Blue Shield *
- Despite What the White House Says, Obamacare Is Deeply Troubled PRI Center for Economics & Innovation
- Get quotes to see how ARPA would work for you.
- ARPA is funded to the tune of $34 Billion for only two years and would change the formulas for health insurance tax credits to make them more generous for most people, and also allow a wider number of individuals to qualify.
- ARPA follows President Biden’s strategy of getting all Americans covered. Modern Health Care 3.8.2021 * NPR *
- Covered CA will automatically check if clients get more subsidies. BUT! your consent to allow Covered CA to check your finances in the Federal Hub, etc. must be up to date. Here’s their quick guide on how to do that.
- ARPA is comprehensive and there are several provisions that we are watching closely that would affect how people pay for their health insurance coverage:
- Removing the cap on subsidies for people earning more than 400% [600% in CA] of the Federal Poverty Level (FPL) –Currently those with a Modified Adjusted Gross Income (MAGI) of more than 400% of the FPL are not generally eligible for Advance Premium Tax Credits (APTC). Additionally, there is legislation that would make the removal of the 400% cap permanent.²
- Lower the maximum a person has to pay for the Benchmark Plan from 9.83% of MAGI to 8.5% of MAGI – This provision would drop the amount the insured person has to pay for insurance from 9.83% of his MAGI to 8.5%.
- Provide no-cost Silver Plans for people receiving unemployment insurance – Americans on unemployment insurance during 2021 would receive the Benchmark Silver Plan in their market for a $0 premium contribution while they are receiving unemployment insurance.⁴
- APRA COVID Stimulus bill will also pay your COBRA and Cal COBRA premium.
- All ages will be affected, but this bill will have the greatest impact on near-seniors, or those aged 55-64 because of the cost of their ACA coverage. Stephens Mathews Email 3.11.2021 *
Resources & Links
- HR 1319 on Congress.Gov
- Congressional Budget Report – Premium Tax Credit
- 242 page pdf of HR 1319
- Insure Me Kevin.com
- Kaiser Foundation Analysis & Summary 3.15.2021
- Cal Matters.org
- Affordability
- HHS Fact Sheet
- IRS Overview
- Covered CA Website on ARPA
- CC March 18th 22 page slide show
- Federal Data Services Hub
- Covered CA FAQ’s for Brokers Rev 5.12.2021
- Target Strategies
- Covered CA Broker Briefing April
- July 28,2021 Press Release
- Covered CA says subsidies are too big to ignore
- Blue Shield tools & explanation
- Sample – Messaging for on-exchange members with a subsidy
- Sample – Messaging for on-exchange members without a subsidy
- Sample – Messaging for switching to an identical plan on-exchange
- Blue Cross Power Point Presentation
- Word & Brown Insurance Wholesaler Summary
- Unemployment Compensation Enhancements Silver 94
- Extensive FAQ from Anthem Webinar
- california healthline.org covered-california-insurance-deals-2022
- Impact of the American Rescue Plan Act on State-Based Health Insurance Marketplaces: Increased Affordability and Access for Consumers
- ACA Health Insurance Enrollment Sets New Record
- Covered CA ONLINE Application – Job Aid
How do the Subsidies under ARPA compare to ACA?
HR 117 ARPA Premium Tax Credit
TAS Tax Tips: American Rescue Plan Act of 2021 individual tax changes summary by year
cnn.com/trump-health-care-complicated
#Covered CA Certified Agent
No extra charge for complementary assistance
- Appoint us as your broker
- 17 Reasons to appoint us as your agent - broker
- VIDEO on ARPA Stimulus and more Covered CA Subsidies
- Set Consultation Meeting via Phone, Skype or Zoom
- Get Instant Health Quotes, Subsidy Calculation & Enroll
- Videos on how great agents are
- I'm in Sonia VIDEO
Technical Links for
Premium Tax #Credits §136 B
CFR 136 B 3 – How is Tax Credit #Calculated
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Kaiser Foundation Subsidy Explanation
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- CFR 155.305 HTML Eligibility Standards
- 26 CFR 1 & 602
- §1.36b-0Table of contents
- §1.36b-1 Premium tax credit definitions
- law.cornell.edu/uscode 1396a
- final regulations,
- proposed regulations relating to minimum value of eligible sponsored plans
- Notice 2013-41, whether or when individuals are considered eligible for coverage under certain Medicaid, Medicare, CHIP, TRICARE, student health or state high-risk pool programs MR. Mip.
- final regulations on the reporting requirements for Marketplaces.
- HR 3590 Section 1001 HR 4872
- Code of Federal Regulations §1.36b-2Eligibility for premium tax credit.
#Native Americans Heath Insurance subsidies, etc
No Health Care Expenses, Depending on Income
Federally recognized American Indians and Alaska Natives who earn less than 300 percent of the federal poverty level (see chart) will not have to pay certain out-of-pocket medical costs, such as copays and deductibles, if they purchase health insurance coverage through Covered California, no extra charge for use to help you. Get Quote
No Cost-Sharing for Covered Services Provided by an American Indian Health Provider or Clinic, Regardless of Income
There are no copays or deductibles for any covered services received directly through the federal Indian Health Service, tribes, tribal organizations or urban American Indian organizations.
Ability to Buy Insurance Anytime
American Indians and Alaska Natives can buy or change health insurance plans once a month through Covered California and are not subject to open-enrollment periods. Our webpage on special enrollment
Exemption from the Shared Responsibility Payment
All members of federally recognized tribes and all American Indians and Alaska Natives who are eligible for services through an Indian Health Service provider are eligible from an exemption from the shared responsibility payment (the tax penalty consumers pay if they do not have minimum essential health coverage). Click here for more exemption information. Our webpage on CA Penalty * Exemptions from CA Mandate Penalty
Additional information that may be of interest to American Indians and Alaska Natives is available below:
- The Centers for Medicare and Medicaid Services’ “Outreach & Education Resources” page
- Information about the Affordable Care Act from the Indian Health Service
- The Centers for Medicare and Medicaid Services’ information page for special populations
- The California Rural Indian Health Board’s website about Covered California and the Affordable Care Act
- The California Consortium for Urban Indian Health
- Covered California Tribal Consultation
- healthcare.gov/american-indians-alaska-natives
- coveredca.com/american-indians
- USA Today – ACA hard sell for Native Americans 10.15.2013
- Tribal Pharmacy Dispenses Free Meds and Fills Gaps for Native Americans in the City KHN.org
More Links
- What tribe are you a member of?
- Check out these links:
- coveredca.com/american-indians/
- ihs.gov/aca/
- ihs.gov/ihcia/
- ihs.gov/forpatients/patientsrights/
- cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Outreach-and-Education
- cms.gov/special-populations
- crihb.org/
- oag.ca.gov/native american
Southern CA
Tongva Territory
- mwgoe.org Many Winters Gathering of Elders – San Pedro, CA
- facebook.com/Many Winters Gathering of Elders/
- Map of Tongva Territory – Scroll Down
#Report changes as they happen - within 30 days! 10 CCR California Code of Regulations § 6496
10 days for Medi Cal 22 CCR § 50185
Our webpage on ARPA & Unemployment Benefits - Silver 94
IRS Form 5152 - Report Changes
- Our VIDEO on how to report changes to Covered CA
- Lost your job? How to keep your Health Insurance. Shelter at Home VIDEO
- References & Links
- Here's instructions, job aid, reporting change in income
- Our webpage on the exact definition of MAGI Income
- If you've appointed us - instructions - as your broker, no extra charge, we can do it for you.
- Voter Registration
- Task Guide Phone - Voter Registration
- Denial of benefits and possible criminal charges if you don't report changes in income!
- Fudging Income?
- Western Poverty Law on reporting changes
- How to cancel coverage.
- Visit our webpage on how to report changes
- VIDEO What is APTC Advance Premium Tax Credit
- Health Net VIDEO How to get subsidies – pay less for coverage
- Interactive Tax Assistant (ITA)
- Am I eligible to claim the Premium Tax Credit?
- IRS FAQ on Premium Tax Credit
- Learn More About Your Health Insurance Tax Documents | Covered California VIDEO
https://www.tampabay.com/news/health/2022/06/06/500000-floridians-could-lose-health-coverage-without-tax-credits-study-warns/
https://news.bloomberglaw.com/employee-benefits/employers-fear-fallout-from-biden-bid-to-expand-health-subsidies
https://cahealthadvocates.org/tribal-nations-medicare/
LA Times – Hugh premiums if ARPA not extended
https://www.fiercehealthcare.com/payers/cms-congress-time-essence-extending-boosted-aca-subsidies