Tax Insights

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Mid-Year Premium Tax Credit Checkup

Now that there is a year of the Health Insurance Marketplace in the books, it is time to assess how having insurance through the marketplace needs to have a mid-season checkup.

If you have insurance through the Marketplace, you may be receiving a premium tax credit. These are paid directly to your insurance company to lower your monthly premium. Changes in your income or family size may affect your premium tax credit.

If your circumstances have changed, you need to adjust the premium assistance you are receiving. You should report changes that have occurred since you signed up for your health insurance plan to your Marketplace as they occur.

Changes in circumstances that you should report to the Marketplace include, but are not limited to:

  • an increase or decrease in your income
  • marriage or divorce
  • the birth or adoption of a child
  • starting a job with health insurance
  • gaining or losing your eligibility for other health care coverage
  • changing your residence

Reporting the changes will help you avoid getting too much or too little advance payment of the premium tax credit. Getting too much means you may owe additional money or get a smaller refund when you file your taxes. Getting too little could mean missing out on premium assistance to reduce your monthly premiums.

Changes in circumstances also may qualify you for a special enrollment period to change or get insurance through the Marketplace. In most cases, if you qualify for the special enrollment period, you will have sixty days to enroll following the change in circumstances.

So, just because you have signed up and have insurance, it does not mean that you can forget about it for the rest of the year.

By Donna H. Laubscher, CPA