National health care reform for people with changing incomes
People who are self-employed or have incomes that change throughout the year may benefit from new ways of determining who can get help paying for health insurance coverage under national health care reform.
These individuals may include:
- Self-employed workers
- People with more than one source of income
- Seasonal or temporary workers
- Couples and families with a self-employed member
National health care reform, also known as the Affordable Care Act (ACA), provides many new opportunities to individuals and families in Massachusetts to get health insurance and, for many people, help paying for it.
Did you know that more people than ever before can qualify for help paying for health insurance coverage under national health reform? This is for two reasons:
- People with incomes that are higher than the income limits under Massachusetts’ health reform law can now qualify for help, and
- Income is calculated differently than the way Massachusetts calculated it under its own health reform programs.
Frequently Asked Questions (FAQs)
Under both Massachusetts and national health reform laws, most people must have health insurance if it’s affordable to them. There can be penalties for not being insured.
The rules around shopping as a small business through the Health Connector have changed. If you are the owner of a business that has no eligible employees other than your tax dependents, you will need to shop as an individual or family, instead of as a small business. However, most of the health plans available to small businesses are the same as the health plans offered to individuals through the Health Connector. And, you may be able to qualify for help paying for your coverage through programs that are available only for individuals and families.
Yes, when you apply, you will be able to find out which programs you can qualify for. The three main ways to get help paying for coverage are through MassHealth (Massachusetts’ Medicaid program), ConnectorCare health plans, and tax credits that lower your monthly insurance premium. All applications for help paying for coverage can be submitted through MAhealthconnector.org, or by filling out a paper application that is used by both the Health Connector and MassHealth.
National health reform raises income limits for people who can qualify for help paying for health insurance. Individuals and families earning up to 400% of the federal poverty level (FPL) who do not otherwise have access to affordable health insurance from an employer or other program may qualify for a tax credit to lower their monthly premium. Here are some examples of the types of household and income levels that are within 400% of the FPL:
- Individuals earning up to $47,520 a year*
- A family of two earning up to $64,080 a year*
- A family of three earning up to $80,640 a year*
- A family of four earning up to $97,200 a year*
*For 2017 coverage
Eligibility for help paying for insurance is no longer determined by your gross (total) income. Under national health reform, Modified Adjusted Gross Income (MAGI) is now used instead. Under MAGI you can factor in business expenses that you write off for tax purposes (your Schedule C losses) when calculating your income. This means that many more people may qualify for help who might not have been able to get it in the past. Most people can look at their adjusted gross income (line 37 on their income tax return) to see what their MAGI number will most likely be. This is an important change to understand for those who are self-employed or have combination income sources that include self-employment income.
In general, an open enrollment period is the only time of year when people who are applying for health insurance can enroll or change a plan for any reason. The 2018 Open Enrollment period is November 1, 2017 through January 23, 2018. However, if you can qualify for help paying for coverage through programs like MassHealth or a ConnectorCare plan, you are able to enroll at any time during the year
. If you do not qualify for help paying for coverage, there are certain qualifying events that allow you to enroll in coverage at other times during the year. Qualifying events include (but are not limited to): adding a dependent through birth or marriage, moving to a new permanent address, or becoming a citizen, national, or lawfully present individual. For more information on qualifying events, go to MAhealthconnector.org
Yes, help paying for insurance through tax credits and low-cost ConnectorCare plans is only available through the Health Connector. Even if you enroll in a plan without help paying for it through the Health Connector, if you end up qualifying for a tax credit based on your income for that year, the IRS will let you to claim the tax credit when you file your taxes at the end of the year. But the tax credit is not available for someone who buys a plan outside of the Health Connector. You can also apply through the Health Connector website at MAhealthconnector.org to see if you qualify for MassHealth coverage.
It’s common for income to change throughout the year, particularly if you are self-employed, have a seasonal job, or more than one job. To get the most accurate tax credit amount, you should let the Health Connector know if you have any income changes during the year, as they happen. If you expect your income to go up during the year, you may want to consider changing the amount of tax credit that you apply to your monthly premiums, so that you take less than the full amount available to you. If you use your tax credit during the year and your actual income is over the amount that makes you eligible, you may need to pay back some or all of the credit. You always have the option of waiting until you file your taxes next year to take the credit on your tax return, instead of applying it to your premiums in advance. This may make sense for you if you aren’t sure what your income will be for the year, and are concerned about having to pay money back at tax time.
The fastest way to apply is online at MAheathconnector.org. You can also apply through a paper application. Download a copy of the paper application from MAhealthconnector.org or call 1-877 MA ENROLL (1-877-623-6765) or TTY: 1-877-623-7773 to have a paper copy mailed to you.
You can explore the information on this website or call Customer Service at 1-877 MA ENROLL (1-877-623-6765) or TTY: 1-877-623-7773. For in-person help, you can work with a Navigator or a Certified Application Counselor at a local hospital or community health center. These are people who have been trained to help you apply through the Health Connector. For a list of people in your area, visit MAhealthconnector.org or call Customer Service.