Information You Need to Use the Estimator
You will need to provide:
- An estimate of your monthly income,
- Your family size, the age of each member, and whether any are enrolled in a qualifying health plan through the Marketplace and not eligible for other coverage,
- Your expected filing status,
- The state and county where you live,
- The cost of the benchmark plan used in calculating the advance payments of the credit if you live in a state that has its own Marketplace,
- The monthly premium for the health insurance in which you are enrolled, and
- The monthly advance payments of the credit (if any).
Your family size and household income is necessary because that information is used to determine your percent of the federal poverty line, which is used in determining the amount of your credit.
The age of each family member, whether they are enrolled in a qualifying health plan through the Marketplace and are not eligible for other health coverage are necessary because that information helps determine eligibility for the credit and is used to determine your benchmark plan. Your benchmark plan amount is also used in determining your credit.
The premium is the total cost of health insurance before any advance payments of the premium tax credit or other subsidies are applied.
The premium tax credit is tied to the benchmark plan - the second lowest cost silver plan available in your area that covers the members of your family (you, your spouse, and your dependents) who are enrolled in Marketplace coverage and not eligible for other health insurance coverage such as employer-sponsored or government-sponsored coverage. The cost of the actual plan you selected might differ from that of the benchmark plan.
There are 5 basic categories of Marketplace insurance plans: catastrophic, bronze, silver, gold, and platinum. Plans in these categories differ based on how you and the plan share the costs of your care. As the metal category increases in value, e.g. from bronze to gold, so does the percent of medical expenses that a health plan will cover. The plans available to you generally depend on where you live, your family size, and the age of each family member.
Catastrophic plans don't meet the requirements for qualified health plans under the rules for the premium tax credit. If you enrolled in a Catastrophic plan, you won't qualify for the credit.
If you purchased your health insurance through the federal Marketplace at Healthcare.gov, the estimator will enter the benchmark plan amount for you.
If you purchased your health insurance through any of the state Marketplaces, you’ll need to enter the cost of your benchmark plan in Step 1 of the computation process to help estimate how your premium tax credit changes when your income or family size changes. If the Marketplace didn’t provide you with the benchmark plan information, you may be able to obtain it by contacting the Marketplace where you signed up for your insurance.