People applying early in open enrollment for advance payments beginning in January 2014, therefore, would have likely had their incomes verified by their 2012 tax returns (as this was the most recent tax return they would have had). Unless applicants actively accounted for changes between 2012 and current income, their subsidies may have been based on an already out-of-date income. People applying toward the end of 2014 open enrollment may have been more likely to use 2013 income in their applications, particularly if they had filed their 2013 taxes before applying, but they still may have experienced changes in income during 2014.
As shown below, household incomes change, sometimes significantly, over the course of a year. Enrollees are expected to contact the Marketplace when they experience changes in their incomes so that their subsidies can be recalculated, but there is as of yet no indication of how often this contact is made.
The law requires that any advance payments received in a year be reconciled against the tax credits for which individuals and families are eligible based on their annual income reported on their tax return. If the advance payment exceeded the amount of the credit for which individuals were ultimately eligible, a portion of the overpayment must be repaid. While the ACA originally limited the amount that had to be repaid to $250 for an individual and $400 for a family, Congress subsequently raised the repayment caps and created a scaled repayment structure, as shown in the table below.
Figure 1: Limits on Repayments For Advanced Payment of the Premium Tax Credit Annual 2014 Income (as a % of 2013 FPL) Maximum repayment amountfor a single individual Maximum repayment amount forcouples and families 100% to <200% $300 $600 200% to <300% $750 $1,500 300% to 400% $1,250 $2,500 Greater than 400% FPL Full amount Full amount Note: Enrollees with incomes that fall below poverty at the time of reconciliation are not expected to repay the tax credit.Source: 2012-24 Internal Revenue Bulletin, § 1.36B–4.
Repayments and Refunds: Estimating the Effects of 2014 Premium Tax Credit Reconciliation | The Henry J. Kaiser Family Foundation.
This was all SO unnecessary! Subsidies will always be wrongly estimated, either too high or too low. It’s time to throw the mandate onto the dust heap of history and replace it with a tax credit for everyone to use to buy into Medicaid as the public option or use to defray cost of private insurance – and make the individual market competitive with the employer market by getting rid of preferential tax treatment of ESI. People should be able to go in and out of Medicaid freely (the ACA locks them into it without choice) and not have to worry about changes in household income or job changes in determining subsidy.