No Asset Tests for ACA Subsidies

Medicaid expansion and ACA subsidies depend on income

There are no asset tests for the ACA's premium tax credits or expanded Medicaid

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The Affordable Care Act's (ACA) premium subsidies (premium tax credits) have no asset test. Neither does the expansion of Medicaid under the ACA. In both cases, eligibility is simply based on income. It doesn't matter how much money people have in the bank or the stock market, or how much their homes are worth. The assistance available via expanded Medicaid or premium subsidies depends only on annual income.

Medicaid Expansion

In the District of Columbia and the 33 states that have expanded Medicaid, Medicaid coverage is available to enrollees with household income up to 138% of the poverty level. The income limit for a single person is $17,236 in 2019, but as the poverty level increases over time, the upper income limit for Medicaid eligibility also increases (asset tests are still used for Medicaid eligibility in some circumstances—for example, elderly people who are in a nursing home being paid for by Medicaid). 

In 15 of the other 17 states (all but Wisconsin and Utah), there are an estimated 2.5 million people who are in the coverage gap, with no realistic access to health insurance—they don't qualify for Medicaid, and their incomes are too low for premium subsidies, which don't extend below the poverty level.

Premium Tax Credits (aka, Subsidies)

In states that haven't expanded Medicaid, eligibility for premium subsidies in the exchange starts at the poverty level and extends up to 400% of the poverty level.

In states that have expanded Medicaid, eligibility for premium subsidies begins where Medicaid eligibility ends (138% of the poverty level) and extends up to 400% of the poverty level.

For a family of four applying for 2019 coverage, 400% of the poverty level is $100,400 in annual income. For a household of two, it's $65,840 in annual income. It's important to note that some applicants don't qualify for subsidies, despite having income that's under 400% of the poverty level. This is especially true for younger people (whose premiums are lower because of their age) and people who live in areas where average pre-subsidy premiums are relatively low. This is less common than it was in 2014 and 2015 because premiums have increased significantly in most areas. But it's important to understand that you won't get a subsidy if coverage in your area is already considered affordable (as a percentage of your income) without a subsidy.

But for everyone with an income up to 400% of the poverty level (except, unfortunately, people affected by the family glitch and the people in the aforementioned Medicaid coverage gap), the ACA guarantees that the second-lowest-cost Silver plan won't cost more than a pre-determined percentage of their income.

What Counts as Income?

Eligibility for expanded Medicaid and premium subsidies under the ACA depend on modified adjusted gross income (MAGI). And there's an ACA-specific MAGI. You start with your adjusted gross income (AGI), which is line 37 on Form 1040 (Line 4 on Form 1040EZ, and Line 21 on Form 1040A).

Then there are three things that must be added to your AGI in order to get your MAGI to determine subsidy and Medicaid eligibility. If you have income from any of these sources, you have to add it to your AGI (if you don't have income from any of these sources, your MAGI is simply equal to your AGI): 

  • Non-taxable Social Security income
  • Tax-exempt interest income (for example, if you have federally tax-exempt municipal bonds)
  • Foreign earned income and housing expenses for Americans living abroad 

Your subsidy eligibility (and Medicaid eligibility in the states that have expanded Medicaid) depends on your MAGI. But there's no asset test.

Some opponents of the ACA have cried foul, complaining that people with millions of dollars worth of investments can be receiving premium subsidies in the exchange. This is true, although investment income outside of a tax-advantaged account (401k, IRA, HSA, etc.) counts as annual income. So a single person who doesn't work but earns $50,000 in dividends—or capital gains if they sell some of their investments—during the year in a taxable account would not be eligible for premium subsidies in the exchange (the income cap for subsidy eligibility is $48,560 for a single individual purchasing 2019 coverage).

Tax Breaks for Health Insurance Are the Norm

But it's also important to note that the ACA's premium subsidies are simply a tax credit. For people who get their health insurance from an employer—which is the majority of non-elderly Americans—there have always been significant tax breaks. The portion of the premiums paid by the employer is tax-free compensation for the employee. And the portion of the premium that's paid by the employee is payroll deducted pre-tax.

There have never been any asset tests—or income tests for that matter—with this arrangement. 

On the other hand, individual health insurance premiums are only fully tax-deductible for self-employed people. People who purchase their own coverage but aren't self-employed (eg, they work for an employer that doesn't offer coverage) can include health insurance premiums in their total medical expenses for the year, but only medical expenses that exceed 10 percent of income can be deducted. And in order to deduct medical expenses that are more than 10 percent of your income, you have to itemize your deductions, which very few people do (the Tax Cuts and Jobs Act significantly increased the standard deduction, so itemizing deductions isn't worth it for most tax filers).

Now that the ACA is providing premium subsidies to more than 9 million people with individual health insurance, it's essentially leveled the playing field in terms of the tax advantages for people who buy their own health insurance and people who get insurance from an employer (although people who earn more than 400% of the poverty level and buy their own health insurance are still at a disadvantage tax-wise when compared with their counterparts who receive employer-sponsored health insurance).

A person with a million dollars in savings but only $30,000/year in income (either investment income or income from a job, or a combination of the two) can benefit from the ACA's premium tax credit. Some opponents of the ACA have lamented that this is unfair and that it's taking advantage of a "loophole" in the ACA.

But if that same person worked for an employer who provided health insurance, she would be receiving tax-free compensation in the form of the employer's contribution to the premiums and would be paying her own portion of the premiums with pre-tax dollars. She might only be paying $100 or so in premiums each month (or nothing at all, depending on how generous her employer is; the average covered single employee pays just under $100/month for their coverage, while their employer pays an average of $476/month). And yet this is rarely perceived as a loophole, nor is it seen as rich people "taking advantage" of the system. 

When viewed from this perspective, the ACA's premium tax credits have simply helped to put individual health insurance more on a par with employer-sponsored health insurance. And yes, they've also made it possible for people younger than 65 to take the plunge into self-employment, part-time work, or early retirement, without having to worry that health insurance premiums will eat up all of their savings before they reach Medicare age.

The tax advantages of employer-sponsored health insurance are not a loophole in the tax code. And neither are premiums tax credits in the individual market for high-assets enrollees.

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