Conrad and SeniyaExample

Conrad and Seniya live in Milwaukee, andthey can’t get health insurance from work.They make $43,000 / year. Using their taxcredits, they found a plan for $175 / month.

Monthly premium: $650Tax credit: - $475Final monthly cost: $175

...you do not qualify for BadgerCare Plus, or other Medicaid programs.

...you cannot be claimed as a dependent by anotherperson. (Married couples must file a joint tax return.)

...you have a low to moderate household income (check chart below).

...you buy insurance from the Health Insurance Marketplace.

$2015YearlySalary

$11,670 -$46,680

$15,730 -$62,920

$19,790 -$79,160

$23,850 -$95,400

$27,910 -$111,640

1 2 3 4 5Number of peoplein household

HEALTH INSURANCE MARKETPLACE

PREMIUM TAX CREDITSalso known as: Obamacare, healthcare.gov, the Marketplace $$$

Premium tax credits help you pay for some or all of your monthly premiumsfor health insurance. The less you make, the more credits you can get.

You Qualify for Premium Tax Credits if . . .

I make too muchmoney to qualify for

BadgerCare+

...you do not get affordable health insurance from your work.What is “affordable” health insurance from your work?The lowest-cost employer plan must be less than 9.66% ofthe total family income for the employee only. This meansthat if your plan from work is affordable for the employee,but not for the family (two or more people), the familycannot get premium tax credits from the Marketplace.

The health plan atmy work is more than9.66% of my salary.

(you must meet all of these requirements)

Monthly premium: $650Tax credit: - $475Final monthly cost: $175

EXAMPLE:

If Conrad and Seniya useall of their tax credits, theMarketplace will pay taxcredits directly to theirinsurance companyevery month.

This lowers their monthly premium payments to thelowest possible cost.

Premium tax credit refund atthe end of the year: $0

Monthly premium: $650Tax credit: - $300Final monthly cost: $350

EXAMPLE:

Conrad and Seniya can pickhow much of the credits theywant the Marketplace to payto the insurance company.

The more tax credits theyuse, the lower their premiumpayments will be.

Premium tax credit refund atthe end of the year: $2,100

Using less might be a goodoption if you have an incomethat changes during the year.

Understanding Tax Credits

Use All Use Some Use None

Monthly premium: $650Tax credit: - $ 0Final monthly cost: $650

EXAMPLE:

Conrad and Seniya can paythe full cost of the monthlypremium for their healthinsurance.

Conrad and Seniya’s taxcredit will be available as atax refund at the end of theyear if they have a planthrough the Marketplace.

Premium tax credit refund atthe end of the year: $5,700

Report all changes inincome to the Marketplace.

If you make more than you reported,you may have to pay back some or allof the financial help.

HealthCare.gov will tell you how much financialhelp your household can get every month to helpyou pay for health insurance in your EligibilityDetermination, based on your income.

You must choose how you would like to get thefinancial help (Tax Credits). Tax credit refundsare separate from other tax refunds.

Conrad and Seniya can get $475 dollars of tax credits every month to help them payfor health insurance. This is a total of $5,700 for the year. Conrad and Seniya mustdecide how much of their $5,700 tax credit to use now, and how much of the$5,700 they will get as a tax refund at the end of the year. The amount they usenow will be split between the 12 months.

Conrad and SeniyaExample

You will lose your financial help(premium tax credits) if you don’t fileyour taxes.

March © 2016 Board of Regents of the University of Wisconsin System. Project support: Wisconsin Health InformationOrganization, Ira and Ineva Reilly Baldwin Wisconsin Idea Endowment, & Wisconsin Department of Health Services.

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developed by:CGHC.EO.1049-2016