Changes to report if you have a Marketplace plan


Let’s say you’re one of the nearly 13 million people who signed up for a plan through the Health Insurance Marketplaces during open or special enrollment. You completed your eligibility application with information that was true at the time. Then, several months later, your family moves to another house. You probably know you’ll need to report the change of address to the Marketplace, but what else do you need to report? Generally, you should report any changes that impact your family size, changes that affect your household income or changes to available health coverage.

Why You Should Report Your Income Changes

The application for Marketplace plans asks for your household’s anticipated yearly income. That means the number that you give is your best estimate of what you think you will earn in the coming year. But the unexpected often happens, for better or worse. In January, you probably didn’t expect your hours in April to be reduced at work, for instance, or for your wife to receive a big raise in September.

When the unexpected does happen and causes your household income to significantly increase or decrease, you should submit this information to the Marketplace as soon as possible. Doing so helps you, too, by saving you money immediately or at tax time by adjusting your premium tax credit assistance to the correct amount. If your income increases to the point that your premium tax credit assistance is higher than you qualify for, then you’ll likely need to repay those extra amounts when you file your federal tax return. On the flip side, if your income drops during the year and you don’t report the change, you could be missing out on premium savings or Medicaid enrollment.

When Your Income Changes and You DON’T Need to Report It

In some cases, your income might increase but won’t need to be reported to the Marketplace. Because financial eligibility is determined by a number known as the MAGI, or modified adjusted gross income, some of your income might not be included in making the calculation. Examples include:

  • You receive an inheritance.
  • Your teenage daughter gets a summer job in which she earns less than $6,300.
  • Your husband is awarded a college scholarship that pays for tuition and related fees.

Report When People Join or Leave Your Household

Your financial assistance eligibility and coverage options are based on your household size. So when the size of your household becomes larger or smaller than when you applied in the Marketplace, report the change to make sure you receive the correct level of assistance. Examples of household changes to report include:

  • Marriage
  • Divorce
  • Death
  • Birth
  • Adoption
  • Placement of a child into foster care

Note that the Marketplace counts foster children as part of your household, but income that you receive as compensation for their care is not counted.

Changes to Your Available Coverage

Notify the Marketplace if you or another household member experiences any changes to the health insurance coverage available. For example, report if:

  • Your son turns 26 years old and can no longer be covered on your plan.
  • You lose your job-based coverage.
  • Your husband is offered job-based coverage.
  • Your dependent mother begins receiving Medicare.

Important Things to Know About Reporting Changes

There is no limit to the number of times you can report changes about your income, household members or changes in insurance eligibility to the Marketplace.

You’ll get a new Marketplace eligibility notice after reporting a life change. This notice will tell you if your life change allows you a special enrollment period, qualifies you for a different amount of financial assistance or makes you eligible for another kind of coverage.

If you have any doubt about whether to report changes to the Marketplace, contact the HealthSherpa consumer advocates, who can explain the rules and how they apply to your situation.

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