A note about the premium tax credit
Households with incomes up to 400% the FPL for their household size may be eligible for a premium tax credit to help lower monthly premium costs.
If you are applying for coverage outside of open enrollment, and you are determined eligible for a premium tax credit because your household’s income is between 300%-400% FPL—please note that eligibility for premium tax credits is NOT a qualifying event in itself unless you are already enrolled in a plan.
Learn more about the premium tax credit on IRS.gov →
How do I determine if my employer-sponsored coverage is affordable for me?
Employer-sponsored (job-based) health coverage is considered affordable—as it relates to eligibility for a premium tax credit through the Health Connector—if your employee share of the annual premium for self-only coverage is no greater than 9.5% of your annual household income.
This means that a job-based health plan is considered “affordable” if the employee’s share of premiums for the lowest cost self-only coverage—NOT spouse or family coverage—that meets the minimum value standard* is less than 9.5% of their family’s income.
You may pay more than 9.5% of your income on premiums for spouse or family coverage from your employer. But affordability is determined only by the amount you’d pay for self-only coverage from your employer.
If you are not sure if you meet the 9.5% affordability standard, you should ask your employer for help figuring out if the plan offered to you meets the minimum value standard*. Your employer can also give you the information needed to determine if the plan is considered affordable to you. One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance worksheet.
*Minimum Value Standard: A health plan meets the minimum value standard if it’s designed to pay at least 60% of the total cost of medical services for a standard population. In other words, in most cases the plan will cover 60% of the covered medical costs and the person with coverage pays 40%.
New Rules for Victims of Domestic Violence
In general, people who are married can only qualify for a premium tax credit if they file a joint tax return with their spouse. However, these rules have recently changed for anyone who is the victim of domestic violence. If you are the victim of domestic violence, filing a tax return separately from a spouse will no longer prevent you from being able get help paying for coverage through premium tax credits.
Because this rule was recently announced, the Health Connector will have a special enrollment period from April 1, 2014, to May 31, 2014, for anyone that this situation applies to. The special enrollment period allows victims of domestic violence to apply for and enroll in health insurance outside of the recently closed open enrollment period.
If you are a victim of domestic violence who did not apply for coverage through the Health Connector during open enrollment:
- Go to MAhealthconnector.org and fill out a new application
- When asked for information about how you plan to file next year’s federal income tax return, indicate that you will file as single/unmarried
- Do not include your spouse on the application and do not include your spouse’s income when answering questions about the household income
- You may also be asked to confirm that you are applying for coverage outside of the open enrollment period because the special enrollment related to domestic violence applies to you
If you are a victim of domestic violence who:
- Is currently enrolled in a Health Connector Plan without help paying for coverage, or
- Tried to apply during open enrollment and did not enroll because you did not qualify for a tax credit
Please call Health Connector Customer Service at 1-877 MA ENROLL (1-877-623-6765), TTY: 1-877-623-7773. Yous will be able to change your tax filing status from your original application and will be able to shop for a new plan with help paying for coverage, if you qualify.