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Affordable Care Act Guidelines for the Advanced Premium Tax Credit (APTC)

Under the Affordable Care Act (ACA), certain individuals may qualify for help with their premiums under

the following circumstances:

  • The insurance policy must be purchased on the Colorado insurance exchange, which is Connect

    for Health Colorado. In states that do not offer their own exchange, the policy must be

    purchased through Healthcare.gov, which is the Federal Exchange.

  • Individuals must apply for Medicaid and get a Medicaid rejection before they can get the APTC.

  • Individuals must be between 138 and 400 percent of the federal poverty level (FPL)

    Individuals/families under 138 percent of FPL qualify for Medicaid and not eligible for the APTC.

  • Families under 250 percent of FPL qualify for their children to be enrolled under the SCHIP

    program through Medicaid, thus not eligible for the APTC if they choose to buy on exchange.

  • Individuals/families under 250 percent of FPL also qualify for a cost share reduction (CSR) on

    their Silver Metal Level plan in addition to their premium subsidy (APTC).

  • For individuals who do not take the APTC, they might qualify for the tax credit when they file

    their tax return, if the buy their policy on the Exchange.

  • Individuals who have access to other “affordable” insurance are not eligible for a tax subsidy.

  • Affordable insurance includes, but not limited to, eligibility for Medicare, Medicaid, SCHIP, VA,

    or affordable employer insurance.

  • The rules surrounding affordable employer insurance are defined by the ACA. If the employer

    insurance is deemed affordable, neither the employee or their dependents qualify for the APTC.

  • The affordable employer insurance definition is based on the employee portion (not

    dependents) of the premium not exceeding 9.5 percent of their W‐2 income.

For more information on premiums subsidies and the Affordable Care Act, contact:

Paul V. LoNigro

GIA Insurance, LLC

303‐423‐0162 ext 100

plonigro@e‐gia.com

www.e‐gia.com

www.facebook.com/giariskmanagement

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