What happens to the Premium Tax Credit if my Medicaid eligibility changes?
It's possible that a Marketplace could tell you that you don't qualify for Medicaid or CHIP and instead direct you to enroll in a Marketplace plan with advance payments of the Premium Tax Credit (APTC). Later on, your circumstances may change, and you may qualify for Medicaid.
So it could happen that you end up with double coverage from both the Marketplace and Medicaid. In this case, you're treated as not eligible for Medicaid or CHIP for purposes of the Premium Tax Credit for the rest of the coverage period (generally, the rest of the plan year). This means that you may still qualify for the Premium Tax Credit.
If you were enrolled in both Medicaid coverage and in a qualified Marketplace health plan with APTC after the Marketplace told you that you were ineligible for Medicaid, you can claim the Premium Tax Credit for these months if you are otherwise eligible.
This means that you wouldn't need to repay the APTC when the double coverage is due to a change in your Medicaid eligibility. Though you still may need to repay APTC for other reasons, such as if your income increases substantially. Enter your premium, SLCSP, and APTC amounts as shown on your Form 1095-A.
The Marketplace may periodically check state Medicaid data to identify people who are enrolled in both Medicaid and Marketplace insurance. If they find that you're enrolled in both programs, they'll tell you to go back to the Marketplace to discontinue your APTC.
If you believe that you may currently be enrolled in both Medicaid and a qualified health plan with APTC, you should contact the Marketplace immediately.
So it could happen that you end up with double coverage from both the Marketplace and Medicaid. In this case, you're treated as not eligible for Medicaid or CHIP for purposes of the Premium Tax Credit for the rest of the coverage period (generally, the rest of the plan year). This means that you may still qualify for the Premium Tax Credit.
If you were enrolled in both Medicaid coverage and in a qualified Marketplace health plan with APTC after the Marketplace told you that you were ineligible for Medicaid, you can claim the Premium Tax Credit for these months if you are otherwise eligible.
This means that you wouldn't need to repay the APTC when the double coverage is due to a change in your Medicaid eligibility. Though you still may need to repay APTC for other reasons, such as if your income increases substantially. Enter your premium, SLCSP, and APTC amounts as shown on your Form 1095-A.
The Marketplace may periodically check state Medicaid data to identify people who are enrolled in both Medicaid and Marketplace insurance. If they find that you're enrolled in both programs, they'll tell you to go back to the Marketplace to discontinue your APTC.
If you believe that you may currently be enrolled in both Medicaid and a qualified health plan with APTC, you should contact the Marketplace immediately.
