Who is eligible?

Individuals may be eligible for a premium tax credit if they meet all of the following criteria:

• Buy health insurance through the Marketplace
• Have annual household incomes between 100% to 400% FPL (Federal Poverty Level)
• Are ineligible for other “minimum essential coverage”
• Are ineligible for Medicare, Medicaid, CHIP or TRICARE programs
• Do not file a Married Filing Separately tax return (unless victim of domestic abuse or spousal abandonment)
• Cannot be claimed as a dependent by another person

Individuals and families may be eligible for savings on out-of-pocket costs if they meet all of the following criteria:

• Have annual household income between 100% to 250% FPL
• Are eligible for a premium tax credit
• Enroll in a CSR Silver-level plan on the Marketplace

Clients are not eligible for a PTC or a CSR if they are eligible for “minimum essential coverage” outside the Marketplace. Minimum essential coverage includes most other types of health insurance such as Medicare or Medicaid. It also includes employer-sponsored coverage that is affordable and provides minimum value. Employers must notify employees if plans meet these two requirements.