Advance Payments of the Premium Tax Credit APTC
ARPA American Rescue Plan Act
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.com/documents-to-confirm-eligibility
- Covered CA Brochure
- KFF Foundation FAQ’s
- 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
- 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
The American Rescue Plan Act ARPA
2021 Federal Stimulus Package
- ARPA subsidies have been extended through 2025 Kff.org * Congress.Gov Section 12001 * under the Inflation Reduction Act signed by President Biden on 8.17.2022
- 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.
- 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
- Insure Me Kevin.com
- Kaiser Foundation Analysis & Summary 3.15.2021
- Cal Matters.org
- 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
- 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
Premium Problems if ARPA isn’t renewed
- BIG problems with premiums for 2023 if ARPA isn’t continued! Learn More Fact Sheet NASHP
- Covered CA Summaries – Generally simpler, plain English and better summary
- american progress.org/11-ways-the-inflation-reduction-act-will-help
- Millions to Lose Coverage if American Rescue Plan PTCs Expire
- Five Things to Know about the Possible Renewal of Extra Affordable Care Act Subsidies
- Projected Coverage and Subsidy Impacts If the American Rescue Plan’s Marketplace Provisions
Sunset in 2023
- Democrats are feeling increased pressure to extend health care subsidies approved during the pandemic
- Delays Extending The American Rescue Plan’s Health Insurance Subsidies Will Raise Premiums And Reduce Coverage
- Reducing Premiums Can Lead to Improved Insurance Coverage Considering the fact that the majority of low-income consumers owe small premiums, researchers suggested that lowering premiums by a few dollars monthly could improve insurance coverage.
- Falling off the Subsidy Cliff: How ACA Premiums Would Change for People Losing Rescue Plan Subsidies
- Costs will increase significantly for nearly 150,000 Californians if Congress lets federal subsidies expire LA Times
- Zero-dollar premiums could improve coverage on ACA exchanges compared to those paying small amount
- 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
Legislation to renew ARPA
- #Inflation Reduction Act of 2022 Wikipedia
- Insurers, providers exposed as clock winds down for enhanced ACA subsidies 7.22
- What’s in the Manchin-Schumer deal
- CMS to Congress: ‘Time is of the essence’ on extending boosted ACA subsidies 6.22.2022
- Build Back Better Act
How do the Subsidies under ARPA compare to ACA?
No extra charge for complementary assistance
- Appoint us as your broker
- VIDEO on ARPA Stimulus and more Covered CA Subsidies
- Videos on how great agents are
Technical Links for
- § 1.36B-1 Premium tax credit definitions.
§ 1.36B-2 Eligibility for premium tax credit.
§ 1.36B-3 Computing the premium assistance credit amount.
§ 1.36B-4 Reconciling the premium tax credit with advance credit payments.
§ 1.36B-5 Information reporting by Exchanges.
§ 1.36B-6 Minimum value.
- CFR 155.305 HTML Eligibility Standards
- 26 CFR 1 & 602
- §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.
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).
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
- 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
- ca health advocates.org/tribal-nations-medicare/
- What tribe are you a member of?
- Check out these links:
- oag.ca.gov/native american
- mwgoe.org Many Winters Gathering of Elders – San Pedro, CA
- facebook.com/Many Winters Gathering of Elders/
- Map of Tongva Territory – Scroll Down
10 days for Medi Cal 22 CCR § 50185
Our webpage on ARPA & Unemployment Benefits - Silver 94
- 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
- turbo tax.com - FREE for simple returns
- H & R Block
- E file.com
- Estimate the Subsidy for Health Insurance, benefits, premiums, etc.
- 8962 ONLINE Calculator
- Tax Form Calculator.com
- e tax.com
- Marriage Higher or Lower Taxes?
- IRS Withholding Calculator