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Health Insurance Premium Tax Credit and Cost-Sharing Reductions (CRS Report for Congress)

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Release Date Revised Feb. 14, 2024
Report Number R44425
Report Type Report
Authors Bernadette Fernandez, Specialist in Health Care Financing
Source Agency Congressional Research Service
Older Revisions
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Summary:

Certain individuals without access to subsidized health insurance coverage may be eligible for premium tax credits , as established under the Patient Protection and Affordable Care Act (ACA; P.L. 111 - 148 , as amended ) . The dollar amount of the premium cred it varies from individual to individual, based on a formula specified in statute. Individuals who are e ligible for the premium credit, however, generally are still required to contribute some amount toward the purchase of health insurance. In order to be eligible to receive premium tax credits, individuals must have annual household income at or above 100% of the federal poverty level (FPL) but not more than 400% FPL; not be eligible for certain types of health insurance coverage, with exceptions ; file fed eral income tax returns; and enroll in a plan through an individual exchange. Exchanges are not insurance companies ; rather, exchanges serve as marketplaces for the purchase of health insurance. They operate in every state and the District of Columbia (DC) . The premium credit is refundable, so individuals may claim the full credit amount when filing their taxes, even if they have little or no federal income tax liability. The credit also is advanceable, so individuals may choose to receive the credit on a monthly basis to coincide with the payment of insurance premiums. The ACA premium credit is financed through permanent appropriations authorized under the federal tax code. Individuals who receive premium credits also may be eligible for subsidies that reduce cost - sharing expenses. T he ACA established two types of cost - sharing subsidies (or cost - sharing reductions) . One type of subsidy reduces annual cost - sharing limits ; the other directly reduces cost - sharing requirements (e.g., lowers a deductible). Individuals who a re eli gible for cost - sharing reduction s may receive both types. Although applicable health plans must provide these cost - sharing reductions, such plans are no longer receiving payments to reimburse them for the cost of providing the subsidies.
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