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APTC Increases and Other Marketplace Changes

From Covering Kids & Families of Indiana 

As part of the American Rescue Plan Act, most Marketplace enrollees will benefit from increased Advanced Premium Tax Credits (APTC) for 2021 and 2022. These higher APTCs will lower consumers’ premiums. New enrollees will automatically see the additional benefits.

Current enrollees will need to update their Marketplace account to receive some of the benefits now or can wait until filing their 2021 taxes to receive the full benefits. Money saved from January until the consumer updates their account can be claimed when they do their 2021 taxes (learn more). To receive additional APTC now, consumers should submit an application update to receive an updated eligibility determination. Consumers need to choose the “report a life change” pathway to update their application and then click the option for “change to my household’s income”, even if all the information on the application remains the same. After submitting the application update and receiving a new eligibility determination, consumers can enter the “plan compare” section of the site and confirm their current plan selection, so that their insurance company receives their new tax credit information.

Consumers can also choose to make a new plan selection. They could save additional money or find a plan that better meets their needs. If switching, consumers should consider how much they have already paid toward their prior plan’s deductible and annual limit on cost sharing. If they are switching plans within the same company, they should check with their insurance company to see if the money they have already paid out will count toward their new plan. If the consumer is switching companies, they should expect to have a new deductible and out-of-pocket maximum.

Other consumers will also see Marketplace benefits from the American Rescue Plan Act and will need to either enroll or update their account as described above:

  • Plan premiums are capped at 8.5% of adjusted gross income eliminating the subsidy cliff at 400% of federal poverty level.
  • Households under 150% of federal poverty level are eligible for $0 premium benchmark plan in 2021 and 2022.  

Also, anyone receiving or determined eligible for unemployment in 2021, regardless of projected or actual 2021 income, is considered to have an income of 133% federal poverty level for APTC and cost sharing reductions (CSR) calculations for 2021. Enrollees will need to update their application once this is implemented in early July. This also means impacted consumers may want to update their application in April and then again in July.

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