ACA PTC Credit when below 100% of FPL - Does it mater what state you live in?

[rsherry8]

Consider a person who is 50 years old, US citizen, no dependents and living in Florida. Since he is single he cannot get Medicaid. Let say his AGI is $10,000. That is below the Federal Poverty Line or FPL . I claim that he can still get an insurance subsidy through the ACA. That is consistent with what I am seeing with Turbo Tax.

However, if I change his address to New Jersey, I claim that he is eligible for Medicaid and not eligible for a subsidy. Since the data entered into Turbo Tax included a subsidy, he should have to pay that back. As such, that should significantly increase is adjustment due. It did not. Am I missing something? Does it matter if he made a good faith estimate that his income would be over the FPL?

[xmasbaby0]

How does New Jersey come into this?   Did the person who was on a healthcare.gov plan move from FL to NJ?   Why are you entering a NJ address?   The marketplace health insurance plans are specific to the states in which the person lives, so if they moved, healthcare.gov should have been informed of that.

If you had health insurance from the marketplace, when you applied for the insurance, you gave healthcare.gov an estimate of how much income you would receive in 2024.  They used that amount to calculate how much of the insurance premium would be covered by the tax credit and how much would be your amount to pay.   So...you had some monthly amounts to pay, and the rest of the cost of having that insurance was paid by the government program.

If you ended up making a higher income than you told them you would receive, they re-calculate how much should have been paid by the program and how much should have been paid by you.   And if your own share of the cost should have been more, they get it back on your income tax return.   

If you actually had less income, you could even get some of the share you paid back on your tax return.

From Healthcare.gov:

If you're enrolled in a Marketplace plan and your income or household changes, update your application as soon as possible.

These changes — like higher or lower income, adding or losing household members, or getting offers of other health coverage — may affect the coverage or savings you’re eligible for.  After you finish applying or enrolling, you may be asked to submit documents to confirm your income.

Discover which changes to report.

Learn how to report changes.

[rsherry8]

The real person did not move to New Jersey. I changed his address to New Jersey so that I would gain understanding. I thought if you live in New Jersey and your income is below the FPL then you do not get a subsidy. Am I wrong about that?

[xmasbaby0]

Sorry---I cannot comment on any of the healthcare.gov rules or plans for NJ.    You can try going to the healthcare.gov site and plugging in NJ to see what you can learn from that site.   The rules  and plans vary from one state to another ---at least to a certain degree.

But I am still puzzled by why you are focusing on NJ if the person with the marketplace plan is in FL.    If they are in FL then what matters are the plans and rules in FL.

[xmasbaby0]

@rsherry8 Another suggestion --- call healthcare.gov with your questions.   800-318-2596

My own experiences with helping several family members enroll in marketplace plans have been that the reps you reach on the 800 number are really good.  And at this time of year when it is not  yet open enrollment, you should not have much trouble getting through to someone who can answer your questions.