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If your income is below 400% of the federal poverty level, there is a cap on the amount you'll have to pay back, even if you received more in assistance than the amount of the cap. However, at higher income levels, you'll have to pay back the entire amount you received, which could be a lot.
But what happens if it turns out you underestimate your annual income? If you already benefited from premium assistance payments, you'll have to pay them back to the IRS when you file your income taxes for the year. These repayments must be made with the 2019 tax return, filed by April 15, 2020.
If you overestimate your income AND you purchase your health insurance on the federal exchange (or state marketplace, depending on where you live), then you will receive all of your qualify subsidy as a tax credit when you file taxes at the end of the year. So let's say I do overestimate my income.
(For 2020 coverage, that upper income cap is $49,960 for a single person and $103,000 for a family of four.) But as premiums have grown, there are some areas of the country where coverage can easily exceed 25 percent of household income for a family just a little above 400 percent of the poverty level.
Obamacare subsidy pay back — income underestimation. The Premium Tax Credit (“subsidy”) is based on your annual income, not just the months you had Marketplace insurance. So if your annual income is higher than what you told the Marketplace, you will need to repay part (or all) of the Advance credit that you received.
Absent gross underestimates of income to qualify for medicaid there is no fraud. Within ACA, over/underestimates of income resulting in the wrong level of subsidy are adjusted by IRS on the next year's tax cycle, but that assumes the person was in ACA and stays there, only the subsidy was off.
If you overestimate your income AND you purchase your health insurance on the federal exchange (or state marketplace, depending on where you live), then you will receive all of your qualify subsidy as a tax credit when you file taxes at the end of the year.
If you earned more than you estimated, and you got a subsidy for your health insurance, you may have to pay back some subsidy. The maximum amount of payback is tied to your actual income.
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