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Instructions

The estimator has entries for your information as of the beginning of the year, plus forms for each month to enter any changes.

For each month that you incurred a change, enter the changes to the premium (if you switched plans, added or removed a family member), your income, or your family members. The tool will make a revised estimate of the credit based on the changes and show the results in the Summary section.

For each new family member, you need to specify the member's age in the drop down list. You only need to specify the age once: either at the beginning of the year or in the month when you added the member to the family. The age of each family member defaults to 0-20.

If you remove and then add back a family member, the tool assumes that person is a new family member and the age will default to 0-20.

For each family member, you need to specify if they are enrolled in a qualifying health plan through the Marketplace and are not eligible for other coverage such as employer-sponsored or government-sponsored coverage.

Using the Estimator

There are four steps to using the estimator: Select the tax year, enter your beginning of year information, enter any changes during the year, and the year end summary.

Step One - Tax Year

Select the tax year. If you need to change the year after you already started Step Two, you will need to clear all the information you entered by clicking "Clear Everything."

Step Two - Entering Your Information

Enter your information as you expect it to be for the year.

  1. Your estimated monthly household income

    Enter your household's total monthly modified adjusted gross income. Optionally, you may use the worksheet that will group your income by type.

  2. Your family size and age of family members.

    This includes yourself, your spouse, and your dependents.

  3. The state and county where you live.

    This is used to look up the cost of the benchmark plan for your area.
    If you live in a state with its own Marketplace, enter the benchmark plan amount.

  4. Monthly total health insurance premiums.

    The monthly premium for your health plan before the advance payments of the premium tax credit or other subsidies.

  5. Monthly Advance Premium Tax Credit

    The amount of advanced premium tax credit payments the Marketplace sends monthly to your insurer.

Step Three - Changes in Circumstances

Select below the month that change(s) occurred that could impact your premium tax credit. Enter the change in that month. Any changes you input for that month are carried forward to the future months.

Premiums
If your premiums change because you switch plans or add or remove a family member.

Monthly Income
Change in monthly income.

Family Members
Changes in your family size. For new members, specify their age and if they are enrolled in a qualifying health plan through the Marketplace and are not eligible for other minimum essential coverage (such as coverage offered through an employer).

Remember, this estimator doesn't estimate the premium tax credit changes when you move to a different ZIP code or you marry or divorce.

Step Four - Results Summary

An estimate of your revised premium tax credit will show here, taking into account any changes you entered.

If you do not update the Marketplace with your changes during the year, an estimate of the difference will show as well. If your premium tax credit though the Marketplace or Exchange doesn't match the advance payments you receive, you may either be eligible for a refund or have to repay part of the advance payments.

KEY TERMS

Applicable Percent

The percent of your income that you are considered able to afford for your and your family's health insurance.

Household income %
of Federal poverty line
Initial % Final %
< 133% 2.0 2.0
133% - 150% 3.0 4.0
150% - 200% 4.0 6.3
200% - 250% 6.3 8.05
250% - 300% 8.05 9.5
300% - 400% 9.5 9.5

Benchmark Plan

The benchmark plan is the second lowest cost silver plan available in your area that covers the members of your family (you, your spouse and your dependents) who are enrolled in Marketplace coverage and not eligible for other health insurance coverage such as employer-sponsored or government-sponsored coverage.

The premium tax credit is the lesser of:

  • The premiums for the plan in which you and/or your family members enroll,

or

  • The premium for your benchmark plan minus your contribution amount.

Contribution Amount

The contribution amount is the amount you are considered to be able to afford to pay for health insurance. It would be the amount you pay if you enroll in your benchmark plan.

Determined by multiplying your annual household income by your applicable percent.

Family

Generally you (if no one can claim you as a dependent), your spouse (if married and both spouses are on the same return), and anyone else that you are able to claim as a dependent.

Federal Poverty Line

The poverty guidelines published by the Department of Health & Human Services.

HHS Federal Poverty Guidelines for 2015.

Eligibility for the premium tax credit for 2016 is based on the 2015 guidelines.

Health Insurance Marketplace

One of the state or the federal exchanges where you can shop for and purchase health insurance.

Health Insurance Premium

This is the total cost of the plan you choose on the Exchange before the premium tax credit is applied.

Household Income

Household income is your modified adjusted gross income (MAGI) and the MAGI of your spouse if you file a joint return, plus the MAGI of your dependents who are required to file a federal tax return.

Modified adjusted gross income is the adjusted gross income as reported on Form 1040 plus any:

  • Foreign earned income exclusion,
  • Nontaxable Social Security benefits (including tier 1 railroad retirement benefits), and
  • Tax-exempt interest.

It does not include Supplemental Security Income (SSI).

Silver Plan

Marketplace insurance plans are categorized by metal levels: bronze, silver, gold, and platinum. The metal level is based on how much the insurer pays for services covered under the plan.

A silver plan is a health insurance plan where the insurer pays on average 70% of the cost of covered services.

The premium tax credit is limited by comparing the cost of your coverage to that of the second lowest cost silver plan that covers you and your family.

If you are enrolled in more expensive coverage, you will pay the additional amount. However, if you are enrolled in coverage that costs less, your share of the premium will also be less.

For more information, go to healthcare.gov