Why don’t I qualify for subsidies?

Why don’t I qualify for subsidies?

If you completed an application or renewal and are eligible for a Health Connector plan, but were not approved for an Advance Premium Tax Credits to lower your month premium costs, or a ConnectorCare plans, this could be for one of the following reasons:

  • You did not select the option to complete an application for coverage and help paying for costs.

    How to troubleshoot: Sign into your account and update your application by following the steps here and select “Change application type” on the “Change Your Information” page of your application.

  • Your income is not in the range of 100% to 400% Federal Poverty Level.

    Note that income can be below 100% FPL if applicant has a certain qualified immigration status. If your income is below 100% FPL and does not have a certain qualified immigration status, member cannot be eligible for subsidies

    How to troubleshoot: You can, first, check your income with the Federal Poverty level chart. Then, sign into your account and check that your income was reported correctly by reviewing your application summary. If you need update your income, you can find a help guide here and even more details and calculator on how to add different types of income in this guide.  To update your income, you can find a guide here.

  • You have access to, or are enrolled, in affordable employer sponsored insurance that meets minimum value standards.

    How to troubleshoot: If you have access to health insurance through your employer and are not sure if it is considered affordable, you can use our worksheet now to calculate your affordability.

  • You have access to or are enrolled in minimum essential coverage, or MEC.

    Minimum essential coverage is any insurance that meets the Affordable Care Act (ACA) requirement for having health coverage. Examples of health coverage that qualifies as MEC include:

    • Most MassHealth (Medicaid) coverage;
    • A Health Connector or ConnectorCare plan;
    • Insurance from a job, including COBRA;
    • Medicare Part A or Part C;
    • Most student health insurance plans;
    • Some other types of coverage recognized by the Secretary of the U.S. Department of Health and Human Services as minimum essential coverage.

    How to troubleshoot: You can see a full list of what coverage qualifies as MEC in this chart from the IRS. If you are not currently enrolled in any of these types of coverage, you may need to review and update your application.

  • You attested to an invalid tax-filing status (as in not a tax-filer or married filing separately).

    How to troubleshoot: If you applied for coverage and help paying for costs, you’ll need to agree to file a tax return even if you have very low income and haven’t had to file in the past. If you are married, you will need to agree to file jointly. If you need to update your tax filing status in your application,  you can sign into your account and follow the guide to update your application here and select the option to “Change a status”.

  • You could be experiencing an error from the IRS not being able to match their information with the information in your application and you may need to manually confirm your income.

    How to troubleshoot: Sign into your account online and update your income or resubmit your application with the same income. Follow the step-by-step instructions here for updating your income online. After you’ve submitted your new information, you may be asked to send proof of your income to the Health Connector.

  • You received Advance Premium Tax Credits in a prior year but did not reconcile them.

    How to troubleshoot: If you did not file taxes for a previous year you received tax credits, then you will either need to file a tax return for that previous tax year. If you did file taxes but did not complete IRS Form 8962, then you may need to amend your past return. For assistance with this, please visit our tax section for more filing information, or you can contact Health Connector customer service for additional help.

Frequently Asked Questions

The goal of having a tax credit is to help make your monthly health insurance premium more affordable. To do this, the Health Connector will compare the amount that the federal government has said you should be able to afford for health insurance each month, based on your household size and income, to the cost of the second least-expensive Silver tier health plan that is available to you. The difference between these two numbers will determine how much money you can get as a tax credit to make your premium more affordable.

If your tax credit is $0, this means there is no difference between the amount that the federal government has determined you can afford, and the amount of the premium for the second lowest-cost Silver plan available for you through the Health Connector (see “How is a tax credit calculated?” above). For example, if the Health Connector has determined that you should be able to afford $100 per month in health insurance, and the premium for the second lowest-cost Silver plan available is $100 per month or less, then your tax credit amount would $0.

If you have questions or need more information about why you may not qualify for subsidies, you can contact Health Connector customer service at 1-877-623-6765 (TTY 1-877-623-7773) or visit a Navigator in your area.

Last Update: October 24, 2018  

May 15, 2017    Applying For Coverage, Eligibility    
Monday, May 15th, 2017|
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