How do I know if I qualify for financial help or premium tax credits?

To be eligible for premium tax credits, an individual must

  • Enroll in a marketplace plan
  • Be ineligible for coverage through an employer or government plan
  • Not be able to be claimed as a dependent by another person
  • Not file a married/filing separately tax return (though exceptions exist for certain victims of domestic abuse or spousal abandonment)
  • Have household income between 100 percent and 400 percent of the federal poverty level.
  • Note: minimum essential coverage includes most employer plans, Medicare, most types of Medicaid, CHIP, and Veterans Administration coverage. Only those with employer coverage that is unaffordable and inadequate can qualify for premium tax credits. There may be other types of coverage that count as minimum essential coverage, but as long as you’re not enrolled in the plan, you generally can still apply for financial help. This includes student health plans, retiree coverage and high-risk-pool coverage.
  • Definition of affordable and adequate employer coverage: For 2016, if the premium for self-only coverage in the lowest cost plan is less than 9.56 percent of household income, the plan is considered “affordable.” If the plan meets minimum value, it is considered “adequate;” your employer can tell you if your plan is affordable and adequate.