No one at Covered California calls the IRS for information and the IRS does not send Covered California any of your information. No one at Covered California will ever see your federal tax return unless you provide it to them.

Kevin Knauss: Health, History, Travel, Insurance
Posts related to calculating the Premium Tax Credit received through Covered California, subsidy, form 8962, MAGI household income.



Lines 24 through 26 of Part II of form 8962 determine if the household is eligible for an additional Premium Tax Credit. In this situation, the final household MAGI was slightly lower than estimated income amount of the Covered California application. The result is that the household is eligible for an additional $23 in Premium Tax Credit. They were eligible for an annual subsidy of $16,832, but only received $16,809.


Column A. Monthly enrollment premiums is the full premium rate for the health insurance that the family members were enrolled in for the month. The important role this dollar amount plays is limiting your health insurance Premium Tax Credit subsidy. You can only receive a subsidy equal to the cost of the health insurance. If you are eligible for a subsidy of $2,500 per month, but enroll in a health plan that only costs $2,000 per month, your subsidy will be limited to $2,000.


Tom received unemployment insurance in 2021. Because of the unemployment insurance, Tom’s household income is 133 percent of the federal poverty level, regardless of his income. That 133 percent of the federal poverty level translates into $0 annual contribution for the second lowest cost Silver plan. Since the second lowest cost Silver plan premiums equaled $15,000 for the year that amount becomes the maximum subsidy allowed. Tom is eligible for an additional $2,318.40 ($15,000 – $12,681.40) in Premium Tax Credit because of the unemployment insurance benefit.


In this example, the annual amount of the SLCSP is $15,000. The consumer fair share dollar amount of $8,500 is subtracted from the $15,000 to yield a Premium Tax Credit amount of $6,500. The difference of $6,500 is divided by 12 to get a monthly Advance Premium Tax Credit subsidy of $541.67 per month.


Taxpayers who have already filed their 2020 tax return and who have excess APTC for 2020 do not need to file an amended tax return or contact the IRS. The IRS will reduce the excess APTC repayment amount to zero with no further action needed by the taxpayer. The IRS will reimburse people who have already repaid any excess advance Premium Tax Credit on their 2020 tax return.


The household contribution percentages progressively increase until they reach 8.5 percent when the Modified Adjusted Gross Income is at 400 percent of the FPL. There is no cap on the household income in order to receive the federal Premium Tax Credit subsidy. As long as the Second Lowest Cost Silver Plan exceeds 8.5 percent of the household income, there will be a subsidy to lower the cost.


The American Rescue Plan is federal legislation that applies to federal Premium Tax Credits. It does not apply to any repayment suspension or forgiveness of the California subsidy. One odd twist is that some consumers may have a higher MAGI, over 400 percent of FPL, and not have to repay the federal subsidy and also pick up the California Premium Assistance subsidy on their California income tax return.


For example, if the annual cost of the SLCSP is $6,200 and 8.5 percent of your household income is $5,000, then the subsidy is $1,200. When divided by twelve months, that would be $100 per month to lower the cost of any health plan offered to you through Covered California. If 8.5 percent of your household income $7,000, and the SLCSP is $6,200, there is no subsidy.


The 56-year-old San Mateo County resident purchased health insurance through Covered California in 2020 and 2021. The estimated income was $45,000. In 2020, after the Covered California subsidy, the individual paid $109.98 per month for the Kaiser Silver 70 plan. In 2021, the Kaiser Silver plan jumped to $285.71, a 160 percent increase over the prior year.

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