This article covers the requirements for ACA Premium Tax Credit eligibility, common reasons a client may not qualify for a subsidy, and how Form 8962 reconciliation may impact eligibility.
If you still have questions about why your client is not receiving a subsidy after reviewing this information, our Producer Support team is happy to help. Send us a message through chat or email us with your client’s name and details, and we can assist with reviewing the situation.
ACA Premium Tax Credit Eligibility
Requirements for ACA Premium Tax Credit eligibility, common reasons clients may not qualify, and Form 8962 reconciliation.
Premium Tax Credit — Quick Eligibility Check
To qualify for the ACA Premium Tax Credit, the client must meet all applicable requirements:
Be enrolled in a Marketplace plan
Not be eligible for or enrolled in other minimum essential coverage, such as Medicare, TRICARE, or qualifying Medicaid or CHIP coverage
Not have access to affordable employer-sponsored coverage that meets affordability and minimum value standards
For 2026, employer coverage is considered affordable if the employee’s share of the lowest-cost plan option for employee-only coverage is less than 9.96% of household income and the plan meets minimum value requirements
Have household income generally between 100% and 400% of the Federal Poverty Level (FPL), based on current Marketplace rules
Not file as Married Filing Separately, unless an exception applies due to domestic abuse or spousal abandonment
Not be claimed as a dependent on another person’s tax return
Purchase coverage through the Marketplace (Premium Tax Credits are not available for off-Marketplace plans)
Common Reasons a Client May Not Qualify
Income below 100% FPL
Clients with household income below 100% of the Federal Poverty Level generally are not eligible for the Premium Tax Credit. The client may instead qualify for Medicaid or CHIP depending on state eligibility rules.
See Medicaid Eligibility and How to Apply for eligibility requirements, 2026 income thresholds, and how the client applies.
Income above 400% FPL
The expanded Premium Tax Credit eligibility that allowed some clients with household income above 400% FPL was scheduled to expire December 31, 2025.
Beginning in 2026, clients with household income above 400% FPL generally are not eligible for the Premium Tax Credit and are responsible for the full Marketplace premium cost.
The standard Affordable Care Act Premium Tax Credits remain available for eligible clients with household income between 100% and 400% FPL.
Access to affordable employer coverage
If a client or their family member has access to employer-sponsored coverage that is considered affordable and provides minimum value, the client may not qualify for the Premium Tax Credit for Marketplace coverage.
For 2026, affordability is determined by comparing the cost of available employer coverage to household income using the current Marketplace affordability percentage.
Eligible for Medicaid or CHIP
A client who is determined eligible for qualifying Medicaid or CHIP coverage cannot receive the Premium Tax Credit, even if the client chooses not to enroll in that coverage.
See Medicaid Eligibility and How to Apply for how Medicaid and CHIP eligibility are determined, including the CHIP-specific rule that a child may qualify even if the parent does not.
Form 8962 — Premium Tax Credit Reconciliation
Clients use Form 8962 to reconcile the Premium Tax Credit when filing their federal tax return.
The form compares the amount of advance Premium Tax Credit (APTC) used during the year with the final Premium Tax Credit amount the client qualifies for based on their actual household income.
Agents should advise clients to keep all Marketplace, income, and coverage documentation needed 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).
Additional Resources
For additional help please contact Producer Support, which is available by chat directly from your account, by phone at (866) 568-9649, or by email at [email protected].