Insurance Exchanges

Beginning in 2014, millions of Americans will become eligible for a new premium tax credit that will help them pay for health coverage. This collection of frequently asked questions explains who will be eligible for this tax credit, how the size of an individual or family’s credit will be calculated, how midyear changes in income and household size will affect tax credit eligibility, and how the reconciliation between the tax credit amount a person receives and the amount for which he or she was eligible will be handled.

Survey data show that the largest barrier to health coverage is difficulty finding a plan that families can afford. Beginning in 2014, the Affordable Care Act (ACA) introduces major reforms, including the start of a new advance payment Premium Tax Credit designed to lower the cost of coverage for qualified families purchasing in the new Health Insurance Marketplaces (exchanges). These advanceable and refundable features of the new tax credits introduce new elements that most consumers haven’t previously encountered. These facts raise the possibility that consumer confusion might be a barrier to using this new program to enroll in affordable coverage.

Advanced Premium Tax Credits (APTCs) are part of a financial assistance program established by the Affordable Care Act that can be used to help lower the costs of premiums for individuals with incomes between 100-400 percent of the federal poverty level. Outreach and education on this complex benefit will be crucial to the success of the program. The following are a collection of resources that states have released to inform consumers about APTCs.

This summary provides an overview of several key statutory functions addressed in the final rule regarding eligibilty and minimum essential coverage.

With open enrollment in new insurance marketplaces set to begin October 1, this analysis provides an early look at insurance premiums in 17 states and DC that have publicly released comprehensive data about their rates and the impact of tax credits that will offset part of the costs for low- and moderate-income families. The analysis compares the premiums in the largest cities in each of the 17 states plus DC for individuals and families in different circumstances to illustrate the insurance rates they might pay, with and without the tax credits.