Insurance Plans

If you need to enroll in a state that doesn't operate it's own insurance exchange you have a number of options for how to complete an enrollment. This page will focus on accurately estimating your income for the coming year to see if you qualify for an Advanced Premium Tax Credit that can pay most or all of the cost of your insurance and possibly qualify you for reduced cost sharing at the same time.

See instructions below for calculating your Modified Adjusted Gross Income (MAGI). MAGI is a formula that the IRS uses for a number of tasks that includes your adjusted gross income plus any non-reportable income like Social Security. Once you know what your Adjusted Gross Income is you can proceed with one of the enrollment options on the other pages or you can call (800) 547-1567 to complete your exchange application to determine your eligibility, compare insurance company rates and cost sharing before you enroll in a health insurance plan. Don't forget to divide that number by 12 when entering your monthly income to your application.

Step 1: Start with your household’s adjusted gross income (AGI) from your most recent federal income tax return. 

Where to find your AGI on IRS tax forms:

  • Form 1040: Line 37
  • Form 1040 EZ: Line 4
  • Form 1040 A: Line 21

Don’t have recent AGI? What if I don’t know my household’s recent Adjusted Gross Income?

  1. Start with “federal taxable wages” for each income earner in your household. You should find this amount on your pay stub.
  2. If it's not on your pay stub, use gross income before taxes. Then subtract any money the employer takes out for health coverage, child care, or retirement savings.
  3. Multiply federal taxable wages by the number of paychecks you expect in 2017 to estimate your income for the year.
  4. You may qualify for tax credits which decrease the amount of your AGI.
  5. Self employed deduct business expenses from your gross to get an estimate of AGI.
  6. You may qualify for tax credits that reduce your AGI and increase your Health Iinsurance Tax Credit (HITC).

Step 2: Add the following kinds of income, if you have any, to your AGI: ·

  • Tax-exempt foreign income
  • Tax-exempt Social Security benefits (including tier 1 Railroad Retirement Benefits)
  • Tax-exempt interest
  • Don’t include Supplemental Security Income (SSI).

Step 3: Adjust your estimate for any changes you expect for 2017.

Consider things like these for all members of your household:

  • Expected raises
  • New jobs or other employment changes, including changes to work schedule or self-employment income
  • Changes to income from other sources, like Social Security, alimony, or investments
  • Changes in your household, like gaining or losing dependents. Gaining or losing a dependent can have a big impact on your savings.

Now you have an estimate of your expected income for 2017. Use this figure when asked to estimate your expected income for 2017. 

Step 4: Please do a trial run using the KFF calculator

Once you have read and understand the instructions above you should do a trial run with an ACA calculcator. Be prepared to enter this information on the application before starting your enrollment.

Remember! You are legally liable for the information in your exchange accounts. If you enter figures that are lower than what happened during the tax year and take an Advance Premium Tax Credit during the year to pay for your health insurance you could be liable to repay as much as the entire amount back to the IRS. If you calculate too high you might not get the coverage you need during the year or pay too much out of pocket for it. You must file taxes in order to settle the account and be eligible to not have to repay the tax credit. My advice is to check quarterly to make sure your actual income matches the information provided in your account. A change in income of $150 per month or more that is expected to last at least two months normally qualifies you for a special election period to change insurance mid-year and should be reported as soon as possible