Will you have to pay back your subsidy?
Marketplace guidelines may require you to....




By now, many of us know that the main component of PPACA allows for individuals to qualify for an Advanced Premium Tax Credit (APTC) who have incomes under 400% of the Federal Poverty Limit (FPL).  The APTC (also know as a "Subsidy") can be used to assist with your monthly health insurance premium payments throughout the year.  As a reminder of what these income limitations are, we have provided a chart that details this based on household size below:


***PLEASE NOTE:  incomes below 133% may qualify for Medicaid and families with income below 200% may qualify for MiChild


What happens if my income changes during the year?

It is important to note that you are responsible for reporting changes in income to the Health Insurance Marketplace if you are currently receiving an APTC.  This can be done simply by calling HealthCare.gov at 1-800-318-2596.  If your income decreases throughout the calendar year you may be eligible for additional tax credits when you file your taxes.  If you income increases you must report this to the Health Insurance Marketplace as soon as it happens so they can adjust your APTC accordingly.

For Example:
  • James Smith is a 45 year old male making $30,000 per year applies for health insurance through the Marketplace for an effective date of 1/1/14
  • Based on his income, James qualifies for an APTC of $43 per month to assist with his premium payments
  • On 7/1/14, James receives a promotion and is now making $50,000 per year in annual salary, making him ineligible for an APTC for the remainder of the year

In this example, James must contact the Marketplace during the month of July to report this additional income so his APTC can be adjusted (or in this case, eliminated).  Should James fail to do this he would be required to repay the $43 monthly tax credit for 6 months (or $258) when he files his taxes.


James Smith goes from making less than 400% of the FPL to over 400% of the FPL so he would have to repay the full amount.  That being said, if his income would have remained under 400% he would have been capped at the amount he would be required to pay back when he files his taxes.  To illustrate this better, we have provided a chart to detail the APTC Payback Limits for those who have an increase in income but remain under 400% of the FPL.


We understand that all of these rules and regulations can be confusing - please contact the professionals at Altruis Benefit Consulting to clarify any questions or concerns you may have!


877.442.5878 | www.altruisbenefit.com | @altruishealth | info@altruisbenefit.com


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