526:, whereby a household that saw an income boost that put them over the 400% line could see a big jump in the cost of their health insurance, turning that income increase into an effective decrease in their take-home income. The provisions of the American Rescue Plan and Inflation Reduction Act temporarily eliminated this cliff by doing away with the 400% limit on PTC eligibility, and also reduced the maximum percentage of income that anyone receiving the PTC would pay for a silver plan from 9.6% to 8.5%.
511:
a four-person household was $ 30,000 in the contiguous 48 states (a somewhat higher measure is used in Alaska and Hawaii). As noted above, however, PTC eligibility has been temporarily extended to all households making more than 100% of the FPL through 2025. (The framers of the ACA intended those making less than 100% of the FPL to be covered by
Medicaid; but not all states used the provisions of the ACA to expand their Medicaid programs as anticipated, giving rise to a
519:
text of the ACA, this income percentage ranged from 2% for those making 100% of the FPL to 9.6% for those making 400%. The PTC subsidizes the difference between the cost of the plan and the law's assessment of a household's ability to pay; because the cost of insurance can vary widely depending on the age and home address of the insured, the PTC can also vary depending on those factors, even for two families of the same size and income.
510:
Under the original text of the ACA, only those households whose income is between 100% and 400% of the federal poverty level are eligible to receive the PTC. The FPL varies based on household size and is adjusted annually for inflation; in 2023, the FPL for a one-person household was $ 14,850 and for
485:
Due to the complex legislative history of the ACA, the final text of the ACA was ambiguous on certain points, and could be read to imply that only those who bought insurance through an exchange run by a state government would qualify for premium tax credits. This ambiguity was the subject of a number
571:
An estimate of the credit may also be applied in advance to insurance premiums as they're paid. However, the precise amount of a household's PTC can only be calculated based on the full year's income, and the difference between the estimated and actual credit is taken into account on the household's
518:
An eligible individual or household purchasing insurance through a health exchange can receive the PTC if the cost of a "silver" insurance plan, defined by the ACA as a plan whose premiums cover 70% of the insured's health care costs, would exceed a set percentage of their income; under the original
497:
in which the
Supreme Court ruled 6-3 in 2015 that the tax credits were clearly integral to the law's functioning, and that "the pertinent statutory phrase" ought to be interpreted in a manner "that is compatible with the rest of the law." This ruling ensured that anyone purchasing insurance from any
481:
operate for residents of each state and for the
District of Columbia; only those people who purchase insurance through the exchanges are eligible for premium tax credits. The drafters of the legislation envisioned that the exchanges would be operated by the state governments, but included a fallback
506:
The calculation of the PTC is a complex process that takes a number of factors into account. In general, the system of individual insurance plans purchased through exchanges created by the ACA was intended to supplement rather than replace the United States' primarily employment-based insurance
435:
of the
Affordable Care Act (Obamacare). The Act was signed into law on March 23, 2010, and specified that the credits are only available to individuals and families who have enrolled in a health plan offered on a healthcare exchange. On May 23, 2012, the Internal Revenue Service (IRS) adopted a
541:: The applicable percentage is based on the individual or family's household income as a percentage of the federal poverty level for their family size. This percentage is used to cap the amount of income individuals and families are expected to contribute toward their health insurance premiums.
490:. Had the challenges regarding the premium tax credits succeeded, the subsidy that was one of the key provisions of the ACA would've been unavailable to most people who the framers of the law intended to receive it. The suits on this topic were ultimately consolidated in
454:
to implement provisions required by the ACA. The IRS did not receive any money for this purpose and is now operating on a budget 7% lower than its 2010 budget. He mentioned two major provisions of this Act, the
Premium tax credit and the
563:
The PTC is then claimed on the individual or family's federal income tax return, and may reduce the amount of tax owed or increase the amount of the tax refund. Calculation is subject to specific rules and regulations set by the
436:
regulation that said tax credits would be made available to eligible individuals who enroll in a health plan through either a state or a federally-facilitated exchange. The IRS based this on their interpretation of
Section 1401.
402:
and was first made available in 2014; it aims to make insurance affordable for lower- and middle-income U.S. residents who do not receive insurance through their employer and whose household income is too high to qualify for
482:
provision for federally-run exchanges in states that did not establish exchanges on their own. In the event, however, most of the exchanges are not run by the states; as of 2023, 30 are operated by the federal government.
553:: The maximum PTC is determined by subtracting the expected contribution, based on the applicable percentage of income, from the premium benchmark. This represents the maximum subsidy the individual or family can receive.
669:
547:: The premium benchmark is the second-lowest-cost silver plan premium available in the individual or family's area through their local health exchange. This benchmark is used as a reference point for calculating the PTC.
432:
865:
507:
system, and those who can receive insurance from their or a family member's employer are not eligible for the PTC, unless the employee's share of the premium is more than 8.39% of their household income.
1190:
439:
On June 11, 2012 the IRS published
Internal Revenue Bulletin: 2012-24 which obtains the final regulations that amend the Income Tax Regulations (26 CFR part 1) under section 36B relating to the PTC.
522:
Because insurance plans for many households, especially those with older members, cost more than 9.6% of 400% of the poverty level, the ACA's original provisions for the PTC created a
232:
220:
592:
by individuals who already received advance subsidies through a healthcare exchange. The form was released by the IRS on
November 17, 2014, without accompanying instructions.
1460:
1124:
1170:
827:
559:: The actual PTC is the lesser of the maximum PTC calculated in the previous step or the actual premium paid by the individual or family for the qualified health plan.
362:
1347:
750:
602:
will be issued, respectively, by a health exchange, insurance company or an employer to taxpayers. The taxpayer will rely on these forms for proof satisfying the
1218:
1118:
774:
Internal
Revenue Bulletin: 2012-24, published June 11, 2012, defines a taxpayer's family as the individuals for whom a taxpayer claims a deduction for a
214:
726:
1475:
684:
649:
208:
761:
The household income is the total of the modified AGI for all individuals in the household except those who are not required to file an income
355:
711:
The
Supreme Court, 2014 Term — Comment: Imperfect Statutes, Imperfect Courts: Understanding Congress's Plan in the Era of Unorthodox Lawmaking
1007:
628:
77:
980:
1557:
1521:
1180:
411:
and meet the law's household income eligibility requirements. Under the ACA, only those households earning between 100% and 400% of the
965:
238:
226:
841:
412:
348:
36:
1506:
1055:
743:(AGI) modified by adding non-taxable items, such as tax-free interest, non-taxable social security benefits and tax-free foreign
131:
1470:
1059:
200:
71:
1175:
1134:
515:
whereby some households have incomes too high to qualify for Medicaid but not high enough to receive subsidies via the PTC.)
388:
144:
1377:
423:
extended that eligibility expansion through 2025. In 2023, more than 14 million people received the premium tax credit.
934:
576:
overestimated the amount they were supposed to receive for the advance tax premium; the average amount owed was $ 800.
399:
1317:
866:"Extenders to drive week — Get ready for Microsoft vs. IRS showdown — IRS expands tax evasion crackdown to Singapore"
714:
762:
456:
416:
267:
1480:
1165:
1087:
179:
173:
167:
22:
83:
828:"Five Things to Know about the Renewal of Extra Affordable Care Act Subsidies in the Inflation Reduction Act"
1542:
1229:
1129:
478:
408:
149:
113:
487:
1437:
1267:
125:
1337:
327:
287:
102:
1247:
1155:
607:
107:
650:"Colorado health exchange users may pay much more for insurance next year - Denver Business Journal"
1516:
778:
under section 151 for the taxable year, which may include the taxpayer, the taxpayer's spouse, and
565:
305:
54:
914:
788:
387:(ACA) through which the United States federal government partially subsidizes the cost of private
1297:
813:
420:
1427:
1199:
451:
119:
62:
1056:
https://web.archive.org/web/20141016191204/http://www.cbpp.org/files/QA-on-Premium-Credits.pdf
1485:
1139:
740:
512:
310:
42:
1552:
1490:
187:
1008:"How Health Care Reform Will Affect Your 2014 Taxes (The Ones You File On April 15, 2015)"
8:
1114:
1110:
1096:
1080:
739:
Income for the purpose of determining the eligibility for, and the amount of the PTC, is
419:
temporarily extended PTC eligibility to anyone making more than 100% of the FPL, and the
384:
629:"Colorado health-insurance buyers may get smaller tax credits in 2015 – The Denver Post"
407:. The PTC is only available to those who purchase insurance through the ACA-established
1547:
1433:
1387:
1367:
1257:
1044:
775:
603:
391:
for certain lower- and middle-income individuals and families. The PTC is a refundable
272:
1307:
959:
890:
1383:
1283:
1277:
584:
The IRS introduced several new forms connected with the Premium tax credit (PTC):
1417:
1211:
1050:
1039:
492:
472:
1452:
1287:
1237:
1073:
333:
315:
1536:
1343:
783:
744:
443:
257:
1034:
941:
1413:
1403:
1397:
523:
320:
161:
915:"Form 8965, Health Coverage Exemptions and Instructions - Obamacare Facts"
1273:
281:
498:
of the exchanges would be potentially eligible for premium tax credits.
1373:
1253:
1006:
Greene-Lewis, Lisa; Cpa, Cpa; Manager, the TurboTax Blog (2014-12-10).
670:"Estimated Total Premium Tax Credits Received by Marketplace Enrollees"
392:
1065:
1353:
779:
599:
589:
460:
431:
The eligibility criteria for the premium tax credit is determined by
1511:
1333:
1323:
1313:
1263:
1243:
891:"IRS Releases Form for Individuals Claiming the Premium Tax Credit"
573:
404:
277:
48:
786:
Married Filing Separately (MFS) are not eligible for the PTC. See
534:
To calculate the PTC, the following steps are generally followed:
233:
Health Information Technology for Economic and Clinical Health Act
1423:
395:, and may be applied directly to the cost of insurance premiums.
66:
842:"The Premium Tax Credit - The Basics | Internal Revenue Service"
727:"Employer-Sponsored Coverage and Premium Tax Credit Eligibility"
1407:
1393:
1363:
1357:
1327:
1293:
985:
689:
221:
Medicare Prescription Drug, Improvement, and Modernization Act
1303:
588:
Form 8962, the Premium Tax Credit (PTC) must be filed with a
450:
conference. He said the IRS requested $ 430 million from the
447:
261:
1125:
Provisions of the Patient Protection and Affordable Care Act
685:"IRS Commissioner Predicts Miserable 2015 Tax Filing Season"
16:
Government subsidy for health insurance in the United States
1171:
Authority for Mandate Delay Act (H.R. 2667; 113th Congress)
1219:
National Federation of Independent Business v. Sebelius
606:. For the tax year 2014 only Form 1095-A provided by a
1005:
1119:
Health Care and Education Reconciliation Act of 2010
1045:
https://www.irs.gov/irb/2012-24_IRB/ar05.html#d0e183
486:
of lawsuits that were part of a broader campaign of
415:(FPL) are eligible to receive the PTC; however, the
215:
Health Insurance Portability and Accountability Act
1047:(Internal Revenue Bulletin: 2012-24 June 11, 2012)
501:
51:/ State Health Insurance Assistance Program (SHIP)
1534:
981:"Obamacare Ushers In Pile Of New 2014 Tax Forms"
459:as two new items that have to be implemented on
209:Emergency Medical Treatment and Active Labor Act
1476:America's Affordable Health Choices Act of 2009
1051:http://kff.org/interactive/subsidy-calculator/
1040:https://www.irs.gov/uac/The-Premium-Tax-Credit
572:tax return. In the 2015 tax year, 1.6 million
1081:
356:
78:Program of All-Inclusive Care for the Elderly
1181:Patient-Centered Outcomes Research Institute
529:
1115:Patient Protection and Affordable Care Act
1111:Patient Protection and Affordable Care Act
1088:
1074:
477:Under the provisions of the ACA, separate
363:
349:
239:Patient Protection and Affordable Care Act
227:Patient Safety and Quality Improvement Act
1035:https://www.irs.gov/pub/irs-pdf/i8962.pdf
37:Federal Employees Health Benefits Program
978:
814:"Federal Poverty Level (FPL) - Glossary"
457:individual shared responsibility payment
1507:Health care reform in the United States
1095:
442:In November 2014 the IRS commissioner,
1535:
1471:Affordable Health Care for America Act
1060:Center on Budget and Policy Priorities
964:: CS1 maint: archived copy as title (
703:
1176:Contraceptive mandate (United States)
1069:
999:
595:Form 8965, Health Coverage Exemptions
145:Health insurance in the United States
1378:New Mexico Health Insurance Exchange
383:) is a mechanism established by the
1558:Personal taxes in the United States
682:
539:Determine the applicable percentage
72:Children's Health Insurance Program
13:
782:. Individuals planning to use the
466:
14:
1569:
1318:Illinois Health Benefits Exchange
1028:
751:"New Premium Tax Credit for 2014"
748:
488:legal challenges against the ACA
417:American Rescue Plan Act of 2021
268:Massachusetts health care reform
1166:Physician Payments Sunshine Act
972:
927:
907:
883:
858:
834:
820:
545:Determine the premium benchmark
502:PTC eligibility and calculation
180:Preferred provider organization
174:Health maintenance organization
168:Exclusive provider organization
23:Healthcare in the United States
806:
768:
733:
719:
676:
662:
642:
621:
566:Internal Revenue Service (IRS)
139:Private Fee-For-Service (PFFS)
84:Veterans Health Administration
59:Prescription Assistance (SPAP)
1:
1230:Health insurance marketplaces
614:
150:Health insurance marketplaces
1481:America's Healthy Future Act
1130:Health insurance marketplace
789:"Frequently Asked Questions"
715:129 HARV. L. REV. 62 (2015).
579:
398:The PTC is one of a host of
114:Health reimbursement account
7:
1438:Washington Healthplanfinder
1268:Connect for Health Colorado
126:High-deductible health plan
10:
1574:
1448:Federal insurance exchange
1348:Health Insurance Connector
1338:Maryland Health Connection
1240:, an option for all states
470:
426:
328:Fair Share Health Care Act
288:Vermont health care reform
103:Consumer-driven healthcare
31:Government health programs
1499:
1459:
1447:
1248:Arkansas Health Connector
1228:
1191:Constitutional challenges
1189:
1156:Essential health benefits
1148:
1103:
608:health insurance exchange
551:Calculate the maximum PTC
530:PTC calculation algorithm
300:Municipal health coverage
108:Flexible spending account
557:Calculate the actual PTC
306:Healthcare in California
1463:from the 111th Congress
1298:Hawaii Health Connector
610:is required by the IRS.
421:Inflation Reduction Act
132:Medical savings account
97:Private health coverage
1461:Other reform proposals
1428:Vermont Health Connect
1200:Burwell v. Hobby Lobby
1135:Contraceptives mandate
600:1095-A, 1095-B, 1095-C
590:1040 income tax return
452:United States Congress
336:(Howard Co., Maryland)
120:Health savings account
63:Military Health System
1486:Healthy Americans Act
1140:Executive Order 13535
979:Speculations, Great.
741:adjusted gross income
513:Medicaid coverage gap
413:federal poverty level
311:Healthy San Francisco
43:Indian Health Service
1491:Medicare for All Act
188:Medical underwriting
1543:Affordable Care Act
1097:Affordable Care Act
1012:The Huffington Post
385:Affordable Care Act
1388:NY State of Health
1368:Nevada Health Link
1258:Covered California
1161:Premium tax credit
776:personal exemption
604:individual mandate
400:ACA tax provisions
377:premium tax credit
273:Oregon Health Plan
252:State level reform
201:Health care reform
155:Premium tax credit
1530:
1529:
1308:Your Health Idaho
1206:Coons v. Geithner
830:. 11 August 2022.
793:Beyond the Basics
729:. 30 August 2023.
683:Ebeling, Ashlea.
631:. 27 October 2014
373:
372:
1565:
1278:Access Health CT
1090:
1083:
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946:
940:. Archived from
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905:
904:
902:
901:
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795:. 8 October 2013
772:
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479:health exchanges
409:health exchanges
389:health insurance
365:
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351:
19:
18:
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1564:
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1562:
1533:
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1531:
1526:
1495:
1462:
1455:
1443:
1418:HealthSource RI
1224:
1212:King v. Burwell
1185:
1144:
1099:
1094:
1031:
1026:
1025:
1016:
1014:
1004:
1000:
991:
989:
977:
973:
957:
956:
950:
948:
944:
937:
935:"Archived copy"
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919:
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773:
769:
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738:
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709:Abbe R. Gluck,
708:
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695:
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493:King v. Burwell
475:
473:King v. Burwell
469:
467:Legal challenge
429:
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340:
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98:
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32:
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1453:HealthCare.gov
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1401:
1391:
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1311:
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1291:
1288:DC Health Link
1281:
1271:
1261:
1251:
1241:
1238:HealthCare.gov
1234:
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1030:
1029:External links
1027:
1024:
1023:
998:
971:
926:
906:
882:
872:. 20 July 2015
857:
833:
819:
805:
767:
749:LISAK, BARRY.
732:
718:
702:
675:
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641:
619:
618:
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613:
612:
611:
596:
593:
581:
578:
561:
560:
554:
548:
542:
531:
528:
524:benefits cliff
503:
500:
471:Main article:
468:
465:
461:1040 tax forms
446:, spoke at an
428:
425:
371:
370:
368:
367:
360:
353:
345:
342:
341:
338:
337:
334:Healthy Howard
331:
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316:Healthy Way LA
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1102:
1098:
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1084:
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1054:
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1046:
1043:
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1038:
1036:
1033:
1032:
1013:
1009:
1002:
988:
987:
982:
975:
967:
961:
947:on 2016-11-30
943:
936:
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1104:Key articles
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162:Managed care
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1553:Tax credits
895:www.bna.com
846:www.irs.gov
282:Connecticut
1537:Categories
1149:Provisions
1017:2016-09-02
992:2016-09-02
951:2016-11-18
920:2016-09-02
900:2016-09-02
876:2016-09-02
851:2023-06-08
799:2016-09-02
780:dependents
763:tax return
756:2016-09-02
696:2016-09-02
655:2016-09-02
635:2016-09-02
615:References
393:tax credit
330:(Maryland)
1548:Subsidies
580:IRS forms
574:taxpayers
1517:Medicare
1512:Medicaid
1500:See also
960:cite web
870:POLITICO
405:Medicaid
278:SustiNet
65:(MHS) /
55:Medicare
49:Medicaid
427:History
67:Tricare
39:(FEHBP)
1408:Pennie
1358:MNsure
1328:Kynect
986:Forbes
747:. See
690:Forbes
241:(2010)
235:(2009)
229:(2005)
223:(2003)
217:(1996)
211:(1986)
164:(CCP)
128:(HDHP)
122:(HSA)
80:(PACE)
74:(CHIP)
1522:SCHIP
945:(PDF)
938:(PDF)
448:AICPA
262:Maine
182:(PPO)
176:(HMO)
170:(EPO)
134:(MSA)
116:(HRA)
110:(FSA)
86:(VHA)
45:(IHS)
1117:and
966:link
375:The
381:PTC
203:law
1539::
1434:WA
1424:VT
1414:RI
1404:PA
1394:OR
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1374:NM
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1354:MN
1344:MA
1334:MD
1324:KY
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1294:HI
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