Premium Tax Credit -- Quick Eligibility Check
To qualify for the ACA Premium Tax Credit, the client must meet all of the following requirements:
Be enrolled in a Marketplace plan for at least 1 month
Not have access to affordable employer coverage or government programs (Medicare, Medicaid, CHIP, TRICARE)
Have premiums paid (either by the client, someone else, or via advance credit) by the tax return due date
Have household income between 100% -- 400% of the Federal Poverty Level (FPL)
Not file as Married Filing Separately, unless exempt due to domestic abuse or spousal abandonment
Not be claimed as a dependent on another person's tax return
Have purchased coverage through the Marketplace (no credit for off-Marketplace plans)
Common Reasons a Client May Not Qualify
Income below 100% FPL: Refer the client to the Department of Social Services to apply for Medicaid or CHIP. Clients with income below 100% of the Federal Poverty Level are not eligible for the Premium Tax Credit.
Income above 400% FPL: With the expiration of the Enhanced Premium Tax Credits (eAPTCs) on December 31, 2025, clients with household income above 400% FPL are no longer eligible for Premium Tax Credits. These clients are responsible for the full premium cost. The standard APTCs under the Affordable Care Act remain available for eligible clients with income between 100% and 400% FPL.
Access to affordable employer coverage: If a client or their spouse has access to employer-sponsored coverage that meets affordability and minimum value standards, the client is not eligible for the Premium Tax Credit on a Marketplace plan.
Eligible for Medicaid or CHIP: A client who is determined eligible for Medicaid or CHIP cannot receive the Premium Tax Credit, even if the client chooses to decline that coverage.
Form 8962 -- Premium Tax Credit Reconciliation
Clients use Form 8962 to claim or reconcile the Premium Tax Credit when filing their federal tax return. Agents should advise clients to keep all income and coverage documentation for tax filing purposes.
For more information about ACA income requirements, see What to Include as Income for ACA.
For information about Cost-Sharing Reductions available with Silver plans, see What is CSR? (Cost-Sharing Reductions).
Need Help?
For questions about ACA Premium Tax Credit eligibility, contact Producer Support at [email protected].