Premium Tax Credit
The refundable federal credit subsidizing ACA marketplace premiums for households between 100 and 400 percent of the federal poverty level (with policy-era variations), reconciled on the tax return.
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Practice This Concept
Under the ACA employer shared responsibility provision, an applicable large employer that does not offer affordable minimum-value coverage to full-time employees may face:
A penalty assessed by the federal government — The employer shared responsibility provision, often called the employer mandate, encourages applicable large employers to offer affordable, minimum-value health coverage to their full-time employees. An applicable large employer that fails to offer such coverage, and has a full-time employee who receives a premium tax credit through the exchange, may be assessed a penalty under the Internal Revenue Code. The penalty is intended to offset the cost of subsidizing employees whose employers did not provide qualifying coverage. This is a key ACA compliance concept tested in the group medical expense area.
National insurance concept
Under the ACA, cost-sharing reductions (CSR) are available to eligible enrollees whose household income is between 138% and 250% of the federal poverty level, provided they enroll in which type of plan?
A silver-level plan — Cost-sharing reductions are a federal subsidy that lowers deductibles, copayments, and coinsurance for eligible marketplace enrollees with incomes between 138% and 250% of the federal poverty level. The reduction is available only to enrollees who select a silver plan; bronze, gold, platinum, and catastrophic plans do not qualify. The insurer receives federal payments to lower the enrollee's cost-sharing, effectively boosting the silver plan's actuarial value for those who qualify. This silver-only link is a frequently tested detail that distinguishes CSR from the premium tax credit, which can be used with any metal tier.
National insurance concept
- Medical ExpenseUnder the ACA employer shared responsibility provision, an applicable large employer th…
- Medical ExpenseUnder the ACA, cost-sharing reductions (CSR) are available to eligible enrollees whose …
- Medical ExpenseUnder the ACA, cost-sharing reductions (CSR) lower out-of-pocket costs for marketplace …
- Medical ExpenseUnder the ACA employer shared responsibility ('pay or play') rules, a large employer th…
- Medical ExpenseCost-sharing reductions (CSR) under the ACA are available to eligible enrollees whose h…
- State RegulationsAn enrollee with household income between 138% and 250% of FPL selects a Silver plan th…
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