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jaxgab
Returning Member

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

No APTC (Advanced Premium Tax Credit) will be paid for this policy.

When you go through a questionnaire at www.healthcare.gov/under-30/#/, the answer clearly seems to be "no".  It says:

   You can be added to your parent’s Marketplace health plan, but they won’t be eligible for a premium tax credit or other savings, regardless of their income.

However, within the IRS instructions for Form 8962 the answer clearly seems to be "yes", because there is an example at page 16 which outlines a shared policy allocation and says:

   Gary and his 25-year-old non-dependent son, Jim, enroll in a qualified health plan. Jim has no dependents. The policy covers Gary, Jim, and Gary’s two young daughters who are Gary’s dependents. No APTC is paid for this policy  ... Gary and Jim are applicable taxpayers and each can take the PTC.
 






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13 Replies

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

It may not be worth the 'fight' for just one year of insurance, but the definition of "dependent" for issuing health insurance is not the same as a Tax Dependent.  For issuing health insurance, "dependent" only has to do with the relationship.  For tax purposes, "dependent" as far more restrictions (living with you, support, etc.).

Here is the legal gibberish:

A group health plan, or a health insurance issuer offering group or individual health insurance coverage, that makes available dependent coverage of children must make such coverage available for children until attainment of 26 years of age.

Restrictions on plan definition of dependent - In general. With respect to a child who has not attained age 26, a plan or issuer may not define dependent for purposes of eligibility for dependent coverage of children other than in terms of a relationship between a child and the participant (in the individual market, the primary subscriber). Thus, for example, a plan or issuer may not deny or restrict dependent coverage for a child who has not attained age 26 based on the presence or absence of the child's financial dependency (upon the participant or primary subscriber, or any other person); residency with the participant (in the individual market, the primary subscriber) or with any other person; whether the child lives, works, or resides in an HMO's service area or other network service area; marital status; student status; employment; eligibility for other coverage; or any combination of those factors. (Other requirements of Federal or State law, including section 609 of ERISA or section 1908 of the Social Security Act, may require coverage of certain children.)

https://www.law.cornell.edu/cfr/text/45/147.120

https://www.law.cornell.edu/cfr/text/29/2590.715-2714



At any rate, it does NOT affect your eligibility for the Premium Tax Credit.

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

Yes, you can still claim the Premium Tax Credit if you otherwise qualify.

That webpage is poorly worded.  It is saying that the parents can not receive the Premium Tax Credit based on the kid's health insurance (because they are a non-dependent).  They can still qualify based on their own insurance.

Just to sure to tell the Marketplace that you son will NOT be a dependent.

jaxgab
Returning Member

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

If I try to sign up for a Marketplace health insurance policy and include my 25 year old non-dependent son, the Marketplace software will prevent you from selecting a policy.  That is what happened one year ago.  Marketplace personnel continue to contend my son needs to have his own health insurance policy.  However, the IRS agent I talked to this week did not agree (#1000571791).  While the Marketplace web page states "You can be added to your parent’s Marketplace health plan, but they won’t be eligible for a premium tax credit or other savings, regardless of their income.", this is not how the Marketplace software works.  The software prevents me from selecting a policy after adding my non-dependent son and Marketplace personnel contend I won't be eligible for PTC.

I also called the Marketplace again this week and requested they open a "problem" and actually talk to the IRS to resolve the discrepancy.  The Marketplace "supervisor's supervisor" refused.  She said the Marketplace and the IRS are like two separate companies and they don't talk to each other.  I then asked to talk to supervisor above her and she abruptly hung up on me.

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

How do you add a non-dependent child to a subsidized family Marketplace plan even though he or she specifically won't be eligible for a premium tax credit?

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

I have stumbled across a possible solution to this problem. I was trying to enroll my 21 year old as part of our plan (so the whole family can share the same very large deductible) and the site also would not allow it. Spent an hour and a half on the phone til they figured out that it wasn't allowing me to enroll because she plans to file her own taxes next year (2020). Once we established that I thought it didn't make sense because she also plans to file her own tax return this year (2019) and we bought a plan as a family for 2019, BUT in November of last year we planned to claim our daughter as a 2019 dependent when we were filling out the ACA application. She is a dancer and part way through 2019 she got a full time gig that greatly increased her income. I asked our accountant and she said we can't claim our daughter on taxes in 2019 because she made too much, but everything is fine since she's still considered part of our "household" for health insurance purposes.

Basically I don't think the healthcare.gov system can handle this particular situation even though we have the right to include our child under 26 even if they are not a tax dependent. When I realized this I asked the Healthcare.gov supervisor on the phone and she denied that their system was wrong. Then I said, so should I just put down on the application that I WILL claim my daughter as a dependent and then not claim her again (as I did for 2019)? And she said I have to speak to an accountant. It wouldn't  be dishonest because we don't know if she'll get the same contract next year and if she doesn't, her income will probably be very low and we could claim her. It's complicated when you're self-employed and the ACA doesn't penalize you if the situation changes beyond paying back any subsidy you used if you under-estimated your income.  Anyway, you might want to ask an accountant, I'll be double checking with mine but considering that's what we did for 2019 and she said it wasn't a problem, I don't see why we can't do it for 2020. Everything gets synced up when you file taxes in the end.

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

Instead of trying to do this yourself on the ACA site I suggest you seek a local insurance agent to assist you.
nerdrap
New Member

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

Curious to know what happened here in 2019 and 2020? I am in the same situation!

nerdrap
New Member

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

so what happened here? I am in the same situation and really anxious if I lose my PTC

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

I am curious too.

BillM223
Expert Alumni

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

We in the Community cannot address how to enter data into the Marketplace website, but we can confirm that the statements made above about the parents being able to get the PTC even if one person on the policy is in fact not a dependent.

 

See the two posts above by TaxGuyBill.

 

@desert crawler

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Pompano77
New Member

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

healthcare.gov is internally inconsistent on this point:

 
 
Non-dependent child under 26
Sometimes
Include them only if you want to cover them on your Marketplace plan.
Non-dependent child or other relative living with you

No

Include them only if you’ll claim them as tax dependents.

MarilynG1
Expert Alumni

If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

You may be able to get a Premium Tax Credit with a non-dependent on your Marketplace policy.  

 

If you share a policy with your non-dependent son who files his own return, you will need to Allocate the Premium between everyone on your policy.  If there are three people on your policy, for example, you could 'allocate' 33% for each of you.

 

Your son may need to enter info from your 1095-A on his return, if he did not receive his own 1095-A.

 

Click this link for info on Allocating your Marketplace Premium. 

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If I add my 25 year old non-dependent son to my qualified health plan policy (i.e. healthcare.gov), can I still claim a PTC (Premium Tax Credit) for myself and my wife?

I had a similar problem when applying for marketplace insurance at the end of 2020 (for the 2021 year).  Clearly, a child that is not a tax dependent can be included in a family health insurance plan BUT the marketplace system wouldn't allow me to do that.   I spoke with 3 or 4 different people and pointed them to examples in the regulations and the tax forms but I couldn't get them to budge.  They kept insisting that the tax non-dependent would need her own policy.  I believe it might have worked if I checked the box to entirely forego the advanced payments of the PTC but I didn't want to do that.  In the end, I re-arranged my affairs to pay more than 50% of her total support to make her a tax dependent and then I included her on the marketplace application as a dependent.

 

I've been told that the marketplace application seems to have a similar glitch with children that might qualify for CHIP or medicaid.  Such a child should be able to be included in the family insurance plan (although the child would not qualify for PTC because the child qualifies for minimum essential coverage).  I understand that the marketplace application doesn't seem to allow for such children to be included on the family insurance plan.    

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