Who is eligible for the premium tax credit (health insurance subsidy)?

The premium tax credit (PTC) is financial assistance that can lower the monthly cost of a Marketplace health insurance plan. If you choose to use the credit in advance to lower your monthly premium, it's called an Advance Premium Tax Credit (APTC).

For Plan Year 2027, you generally need to meet all of the following requirements to qualify for the premium tax credit:

1. Your household income is within the eligible range

Your expected household income for the year you're applying for coverage generally needs to be between 100% and 400% of the federal poverty level (FPL).

The Marketplace uses your expected household income for the coverage year, not simply your income from the previous year.

Your household generally includes you, your spouse, and your tax dependents, even if some household members aren't applying for health coverage.

2. You file the appropriate federal tax return

If you're married, you generally need to file your federal tax return jointly to qualify for the premium tax credit.

There are exceptions for certain people who are married but qualify for a special rule because of domestic abuse, domestic violence, or spousal abandonment.

If someone else claims you as a tax dependent, you generally can't receive a premium tax credit based on your own income.

3. You don't have access to affordable employer-sponsored coverage

You generally can't receive a premium tax credit if you or a family member has access to an employer-sponsored health plan that meets the federal requirements for affordability and minimum value.

Certain employer arrangements, such as an Individual Coverage HRA, can also affect your eligibility for Marketplace financial assistance.

4. You aren't eligible for certain government coverage

You generally can't receive a premium tax credit for a person who is eligible for qualifying government coverage, such as Medicare or Medicaid that counts as minimum essential coverage.

CHIP and some other government programs can also affect eligibility for Marketplace financial assistance.

If you're denied Medicaid or CHIP, you may still qualify for a premium tax credit if you meet the other requirements.

5. You meet the Marketplace's citizenship or immigration requirements

You must be a U.S. citizen, U.S. national, or eligible noncitizen to receive the federal premium tax credit.

For 2027, new federal rules limit APTC and income-based cost-sharing reductions to citizens/nationals and noncitizens who meet the federal definition of an eligible noncitizen.

This is different from simply being eligible to enroll in a Marketplace plan. Some lawfully present immigrants may be able to purchase a Marketplace plan but may not qualify for federal financial assistance based on their immigration status.

What if my income or circumstances change?

Your eligibility for financial assistance can change during the year if your income, household size, employer coverage, or other circumstances change.

If something changes, update your Marketplace application as soon as possible. This can help make sure you're receiving the correct amount of financial assistance and reduce the chance of owing money when you file your federal taxes.

How much financial assistance will I get?

The amount of your premium tax credit depends on your household information, expected income, and the cost of Marketplace coverage available to you.

The Marketplace calculates the amount you're eligible for when you apply. You can choose to use all, some, or none of your available tax credit in advance to lower your monthly premium.

If you use APTC during the year, you'll reconcile the amount you received with the amount you were actually eligible for when you file your federal tax return.

Important: Eligibility for a premium tax credit is different from eligibility to purchase a Marketplace plan. You may be able to enroll in a Marketplace plan without qualifying for financial assistance.