Do I Have To Repay Premium Tax Credits If The Marketplace Miscalculated Them?

This week I answered questions from readers who are running into difficulties with premiums and tax credits on their marketplace plans.

My 63-year-old husband has Alzheimer鈥檚 disease. Our annual income is $41,000, from a combination of his Social Security disability insurance (SSDI) and a disability policy he had from a previous job. Last year I bought a single policy on the health insurance exchange. My husband gets coverage through the Veterans Administration. The monthly premium was reduced by a $278 tax credit based on our estimated annual income. Now I鈥檓 reviewing IRS form 8962 that鈥檚 used to reconcile what we received in premium tax credits against what we should have received based on our actual income. It looks like we鈥檒l have to repay $2,500! We can鈥檛 afford that. If the marketplace made a mistake in figuring our tax credit, do we still have to pay the money back?

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If you received too much in premium tax credits, you鈥檒l generally have to pay some or all of it back. Health policy experts say they know of no provision in the health law or rules that would excuse someone from repayment if聽 an error that resulted in a tax credit overpayment was made by the online marketplace. An administration official didn’t respond to a request to clarify whether those situations would be handled differently than if someone underestimates their own income and receives too much.

The amount you鈥檒l have to . A couple with an income between 200 and 300 percent of the federal poverty level ($31,460 to $47,190 for a family of two in 2014) would have to repay up to $1,500. (People with incomes above 400 percent of poverty –$62,920 for a couple — would have to repay the entire amount.)

It鈥檚 hard to know if or where an error occurred.聽It鈥檚 possible that you or the marketplace calculated your income incorrectly. SSDI counts as income when figuring your eligibility for premium tax credits, but disability insurance payments received from an employer policy depending on who paid the premium, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)

Perhaps you or the marketplace entered information incorrectly, transposed figures or made some other manual or computer entry error.

By early February you should receive Form 1095-A from the marketplace detailing how much you received in tax credits for reconciliation purposes. It will be important to use that to make sure your calculations on Form 8962 are correct.

If you discover there was an error in your premium tax credit last year, you鈥檒l still have time to sit down with a navigator to go over your before open enrollment ends Feb. 15.

鈥淚f she made a mistake, she doesn鈥檛 want to compound it by making it again,鈥 says Pollitz.

I had coverage through a health insurance marketplace plan last year, and this year I鈥檓 told my costs will increase significantly. The actual premium the insurance company will charge won鈥檛 change and my income hasn鈥檛 changed. But the amount of premium tax credit I receive will go down. What can I do?

Before you renew your coverage with the same plan you had last year, go back to the marketplace and check out what else is available. It sounds as if the benchmark plan in your area may have changed, and that could mean a higher bill for you unless you switch plans.

Here鈥檚 how it works: Premium tax credits are based on the second-lowest-cost silver plan in your area, called the benchmark plan. If the cost of the benchmark plan this year is lower than it was last year, your tax credit may be lower as well. That鈥檚 not a problem if you switch to the new, cheaper benchmark plan. But if you renew your old plan, in cost between its higher premium and that of the new benchmark plan.

鈥淓ven though your premium didn鈥檛 change and your income didn鈥檛 change, you could see a significant difference in what your contribution is because the premium for the second lowest cost silver plan is different,鈥 says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

I am being told that I must furnish automatic debit card information before an insurance company will provide me with coverage through the exchange. Can they do that?

Health insurers that sell coverage on the marketplaces , says Sandy Ahn, a research fellow at Georgetown University鈥檚 Center on Health Insurance Reforms. That includes paper and cashier鈥檚 checks, money orders, electronic funds transfers and pre-paid debit cards.

An insurance industry representative said this sounded like a misunderstanding. 鈥淧lans accept various forms of payment and wouldn鈥檛 limit a consumer only to a debit card,鈥 says a spokeswoman for America’s Health Insurance Plans, an insurance industry trade group. 鈥淗ealth plans regularly work with their members to establish the payment plan that works best for them.鈥

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