Advance Payments of the Premium Tax Credit APTC

Subsidies

#COVID19 Bill

The American Rescue Plan Act  ARPA

2021 Federal Stimulus Package
March 2021

VIDEO Introduction to ARPA  by Steve 

 

There might – will be big increases in 2022 when subsidies are lost, especially the unemployment benefit.

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 *

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

Steve Shorr VIDEO on subsidies
Health Care Reform

Steve Still Video's

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. 

 

 

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

Get FREE #Instant Individual & Family  California  Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Claus

Get FREE Instant Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Clause

Full Instructions to use Individual Quote Engine
Takes all the complexity out of CFR §1.36B-3 *

how to get quote - full instructions video by steve

#Line8b 11 Adjusted Gross income then add line 2a, 6a &   8 (Foreign Income)

to get Covered CA MAGI Income

MAGI Income from 1040

1040 Form   ***  Schedule 1  Additional Income & Adjustments to Income

Steve's Video on MAGI Income  *  Covered CA's Video *

Federal Poverty Level &
Program Chart

Medi-Cal?  Covered CA Subsidies?  Enhanced Silver?
MAGI Income Chart

#Native Americans

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 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. (Click here for information about federal poverty levels.)

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:

healthcare.gov/american-indians-alaska-natives

coveredca.com/american-indians

USA Today – ACA hard sell for Native Americans  10.15.2013

More Links

What tribe are you a member of?

Check out these links:

https://www.coveredca.com/american-indians/

https://www.ihs.gov/aca/

https://www.ihs.gov/ihcia/

https://www.ihs.gov/forpatients/patientsrights/

https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Outreach-and-Education/index.html

https://marketplace.cms.gov/outreach-and-education/special-populations.html

https://crihb.org/

https://oag.ca.gov/nativeamerican

Southern CA

Tongva Territory

mwgoe.org  Many Winters Gathering of Elders – San Pedro, CA

facebook.com/ManyWintersGatheringofElders/

 

Covered CA Certified Agent

#Covered CA Certified Agent  

No extra charge for complementary assistance 

Videos on how great agents are

I'm in Sonia VIDEO

I'm in Sonia

 

Technical Links for

Premium Tax Credits §136 B

CFR 136 B 3 – How is Tax Credit #Calculated 
cfr.136.b

Kaiser Foundation Subsidy Explanation 

kaiser.foundation.subsidy.explanation

 

 

CFR 155.305  HTML Eligibility Standards

26 CFR 1 & 602

§1.36b-0Table of contents

§1.36b-1 Premium tax credit definitions

http://www.law.cornell.edu/uscode/text/42/1396a

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.

Citation for 9.5 %


HR 3590   Section 1001 HR 4872
Code of Federal Regulations §1.36b-2Eligibility for premium tax credit.

3 comments on “APTC Advance Premium Tax Credit – Subsidies – Introduction

  1. give Medicare the power to negotiate for lower drug prices, add new benefits to Medicare

    Adding dental, hearing and vision benefits to Medicare.

    Making new investments in home and community-based services to “help seniors, persons with disabilities and home care workers,”

    Extending a boost to ACA income-based subsidies that were included in the American Rescue Plan Act. The boosted subsidies are set to expire after the 2022 coverage year.

    https://www.fiercehealthcare.com/payer/framework-for-3-5t-senate-package-seeks-to-close-medicaid-gap-add-new-medicare-benefits-and

  2. 7 comments on “Tax Loss – Negative MAGI Income – Medi Cal? Subsidies?”

    1. Anonymous says:

      I have a wife and 13 year old daughter. Our household income is under $40,000.00 BUT, thanks to a hefty loss carryforward, my MAGI is -$150,000.00.

      Is there any way to get covered California, at least for my wife and daughter (I have Medicare)?

      Reply
      • Steve Shorr says:

        No problem getting health coverage, you just won’t get subsidies. Click here to get quotes and enroll online.

        Reply
        • Anonymous says:

          1 This year I am earning $20,000.00. I have Medicare Advantage. My wife and daughter currently have Medi-Cal.

          2 I’ve just started receiving Social Security which will be $22,000.00 next year. If I continue earning $20,000.00 from working, our total income of $42,000.00 will knock my wife out of Medi-Cal, at least as I understand it.

          3 My daughter, however, can continue with her Medi-Cal.

          4 This is why I’m looking at insurance for my wife and not necessarily for my daughter.

          5 If we have to pay $12,000 to $15,000 for health insurance, maybe I should stop working and leave my wife (and daughter) on Medi-Cal.

          Reply
          • 2 Here’s the income chart for Covered CA While $42k would put you in Silver 73, the chart goes by MAGI Modified Adjusted Gross income that is Line 37 Adjusted Gross Income of your tax return, plus Social Security (It might not count in full), Foreign Income and Exempt Interest.

            Your tax loss would show on line 13 or 14, right? Thus as a negative number it would make your $42k below zero, right? Thus, since your income is below $34k for a family of four, that would put you in Medi-Cal and not subsidies.

            I’m not a CPA or tax attorney. Please review the Government Documents cited, this website and our Medi-Cal websiteWestern Poverty Law and go over them with appropriate counsel.

            4. If you put your mouse over the premium on my quote engine, it will show the premiums for each person.

            5. There are some who say that Obamacare will die on it’s own. The Middle Class can barely afford their own premiums, let alone the subsidies and Medi-Cal.

            Reply
            • Anonymous says:

              Line 13 & 14 of Tax Return – A picture is worth a thousand words

              Reply
              • Anonymous says:

                Letters from Covered California / MediCal said that with our household sized our household earnings could be up $2,2014.08 per month for my wife to stay on Medi-Cal and $4,527.00 for my daughter to stay on Medi-Cal.

                The renewal forms ask about our monthly earnings (wages) and income (I assume this includes Social Security) and nowhere mentions MAGI so it’s quite a surprise to me to find that our qualification is MAGI-based.

                I need to thank you for letting me know this.

                Reply
                • The forms MC 216 and information that I have on my Medi-Cal Redetermination Page – ask for tax deductions.

                  It’s a shame that Medi-Cal and Covered CA give out conflicting and confusing information and then demand that Agents facilitate enrollment without training or compensation.

  3. 8 comments on “Tax Credits & Subsidies Introduction”

    1. Anonymous says:

      I plan to retire in a year or two…

      How long will the ARPA subsidies last?

      How might I figure out what subsidies would be if ARPA goes away?

      Reply
    2. Anonymous says:

      Hello Steve

      I am a stay at home mom and my husband works full-time. We have health insurance through his Employer.

      We feel that our insurance premiums are ridiculously high and last year we only went to the doctor a total of six times.

      We are thinking about switching to a high deductible plan and And enrolling in HSA Account.

      My question to you is do we have to wait till the end of the year to enroll and switch plans or can we through the new special enrollment switch now. what should we do.

      Stacey

      Reply
      • Do you mean switch employer plans or drop the employer plan and get an Individual Plan?

        I’m not aware of any open or special enrollment periods that would apply for Employer Plans in your situation. Here’s our webpage on Individual Special enrollment.

        Here’s our webpage on when there might be special enrollment times for employer plans.

        What percent of the premiums is your employer paying?

        If you drop the employer plan to get an individual plan, it might disqualify the employer from providing coverage to everyone else, as there are minimum participation requirements.

        There are also rules that you might not get any Covered CA subsidies if you are offered an Employer Plan – aka Family glitch.

        You can get individual quotes here. The rules under ARPA are complex… If not for the Family Glitch, you might be able to switch now.

        Here’s our page on HSA’s Health Savings Accounts.

        Reply
        • Anonymous says:

          Thank you for your swift reply. My Husband gets aprox 1400.00 a month taken out of his check each month. I guess I will check with the HR department of possibly un-enrollment of our current health plan through his employment. If this is at all possible we will check back with you, In picking the right plan for our needs.

          Thanks again

          Reply
          • Please use our quote engine first and double check on the Family Glitch. No point in bothering HR if you can’t get something better individually. Do NOT cancel group coverage, till we have double and triple check.

            President Trump was not kidding when he said Insurance was very complicated, more than anyone knew, except Steve Shorr. https://www.cnn.com/2017/02/27/politics/trump-health-care-complicated

            Reply

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