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Be Careful Stating Income For Health Insurance Subsidy
You’ll Have To Pay The Extra Back!
Calculating Your Insurance Subsidy
The “Advanced Premium Tax Credit” (APTC) is the “subsidy” (the monthly amount the government is paying to help you pay your premiums) that helps you afford your health insurance plan. Receiving a subsidy is great, but you must get your income correct. When you claim you will make a certain amount of money in a year (and receive a subsidy), you must try to be as accurate as possible and notify them of any changes that may occur throughout the year. Be honest in stating your income. There are very serious consequences to playing games with your income.
Why Reporting the Correct Income Matters
If you are applying for a government subsidy, please note, anyone living in the household (that is working) needs to provide their income. So, if you have a 21-year-old adult child that is working and is going to be on their parents plan, you must include their income as part of your “Household Income”. Even if they do not live at home. If they are on their parents plan, they will need to provide their income.
The term “household income” means, with respect to any taxpayer, an amount equal to the sum of the modified adjusted gross income of the taxpayer, plus the aggregate modified adjusted gross incomes of all other individuals who were considered in determining the taxpayer’s family size and were required to file a tax return imposed by section 1 for the taxable year.
IMPORTANT! Household Income is defined in 26 US Code 36B(d)(2)(A):
You’ll Have To Pay The Extra Back!
Whenever your income increases or decreases, it’s very important to contact your health insurance agent to update your new income. This way you can have your health insurance subsidy adjusted so you receive the amount you are entitled to. You don’t want to owe the IRS money at the end of the year because you received too much subsidy.
Also, any “Life Event” will affect your subsidy and you must let them know of the changes. The subsidy you receive to help pay for your health insurance is calculated on family size and income and adjusts to any changes in these calculations. It can be an on-going process. When you fill out a health insurance application through their website and get a subsidy, you are responsible to contact them and make corrections if you have any changes throughout the year.
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Get Additional Financial Assistance!
Do you make less than 250% of the Federal Poverty Level?
Receive Additional Assistance!
There is additional assistance called a Cost Sharing Reduction→CLICK FOR DEFINITION← This is in addition to a Subsidy→CLICK FOR DEFINITION←
Check the subsidy chart below ⇓
If your family size and income ranks you under 250% of the Federal Poverty Level→CLICK FOR DEFINITION← you are most likely going to be eligible for additional assistance to reduce your overall out of pocket medical expenses like lower deductibles, and/or co-insurance, and/or out of pocket maximum, and/or co-pays. You must apply, and the enrollment process determines if you are eligible for the “Cost Sharing Reduction”.
This benefit is only available when you buy a “Silver” plan
If your income is under 250% of the Federal Poverty Level, this “Cost Sharing Reduction” will cover more of your portion of the medical expenses. So in addition to getting the “Advanced Premium Tax Subsidy”, you’ll also have the “Cost Sharing Reduction” toreduce deductibles, co-pays, and/or co-insurance. If your income is under 250% of the Federal Poverty Level, this is a very important financial benefit you’ll want to take advantage of!
Sadly, we’ve seen when Nevadan’s enroll into a health insurance plan WITHOUT help from a broker/agent. They buy the cheapest health plan available, shopping for the cheapest premium possible, and remove themselves from being eligible for the “Cost Sharing Reduction”.
If they simply understood this benefit, in some instances for just a few dollars more a month, their deductible could go from around $7000 (example) down to sometimes as low as $0!
Considering there is no charge for an agents assistance, it just makes sense to use a professional.
Subsidies Directly Tied to Your Tax Returns
The subsidies you receive are directly tied to your tax returns, so if you have income changes or life events, you must make certain that these changes get reported. If you forget to make an adjustment to your income or your family size, and the government keeps subsidizing your health insurance, you will have that money taken out of your tax refund when you file your taxes. The IRS at the end of the year will adjust what you’ve received, and what you should have received, and that will be taken from your tax refund, or worse, you’ll have to pay the IRS back. If your income went down, or you had more people in your family to support on the same income, then you may be entitled to get a larger tax refund or receive a larger subsidy.
For example: If your health insurance premiums are $1,000/month and you get a Government Subsidy of $800/month you’ll only have to pay $200/month. At the end of the year when you do your taxes, the Government will check your income. IF you were only supposed to have received an Advanced Premium Tax Credit (Subsidy) of $700/month instead of $800/month, you’ll owe the Government an extra $100/month X 12 months which equals $1,200. Ouch!
Have Changes? Simply Call Us
We suggest that any time you have a change to your income or your family, that you call us. Let us know of the changes and we will take care of making the adjustments to your account to keep your account updated and out of trouble.
Does Your Income Change Regularly?
If you have an income that goes up and down monthly, you’ll want to make those changes monthly, or try to average the income out monthly and divide by 12 months. You can also estimate your yearly income and at the end of the year, the IRS will calculate if you were over-subsidized (received too much subsidy and you owe money), or under-subsidized (you get a refund).
What’s The Most I Would Have to Repay the IRS?
Repayment Limits for Advanced Premium Tax Credits: 2024 Tax Year
You must repay the difference between the amount of premium tax credit you received and the amount you were eligible for. There are also dollar caps on the amount of repayment if your income is below 4 times the poverty level.
The IRS States You Are Responsible
The IRS stated that people who miscalculated their incomes, or if the website (Nevada Health Link) miscalculated their “Subsidy”, whether intentional or not…would be responsible. People who enrolled into a health insurance plan and received a government subsidy, if their subsidy was miscalculated and you were given more than entitled, you will be required to pay this money back.
We gently warn our customers to be honest and careful when doing your health insurance plans through Nevada Health Link. If you intentionally or unintentionally miscalculate your income, there will be a settlement with the IRS when you do your taxes. This notice is not meant to scare you, but to educate and inform you.
This just solidifies our long-held view that you need to be very careful and accurate when you apply for a subsidy from the Government to help pay your premiums. Ensuring that you accurately state your “MAGI” (modified adjusted gross income) is very crucial. If you don’t know your MAGI, you can ask your accountant, or click for definition. After you have your MAGI, you can call us for assistance in obtaining your health insurance plan.
Discussing Subsidies With Nevada Insurance Enrollment
Navigating through the many options of insurance can be confusing and difficult, but speaking with a local, licensed insurance agent will help you to obtain the coverage you need and receive subsidy you deserve. We have licensed health insurance agents ready to assist you with all of your health insurance concerns. We will guide you and help you choose a health insurance plan based on your needs and budget. Call us today!
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