My husband and I are self-employed in our own business. We pay out of pocket, not through our business for our health insurance, because that tax rules do not allow our business to do this.

Our work is inconsistent, sometimes good, sometimes not. So for 2014, we had a (joint) AGI of around $57000 (which includes a deduction for $12,000 for paying for our own health insurance) which would qualify us for subsidies, because we had a less than stellar year.

We have always had health insurance, never not, but did not enroll for subsidies because we didn’t know we would have a bad year.

1st question: Can we retroactively get subsidies?

2nd question: The deduction for health insurance is what brings our AGI below into the subsidy level. Therefore, by getting a subsidy we might not qualify for the subsidy, correct? For example if we had a subsidy that paid half of that $12000, then we would deduct only $6000 and our AGI would have been $63,000.

We have health insurance for 2015 I believe at the silver lever.

Third question: can one enroll for a subsidy and not take it and, if it is in play, get the refund at the end of the year? It is such a moving target for us, what we will make each year.


If you have a Marketplace health plan you can retroactively get subsidies, if your income fluctuates consider taking only partial credits upfront or none at all, also if you get a Silver plan you can adjust cost sharing amounts throughout the year at no extra cost.

You can take credits up front by going into your account adjusting the amount of Advanced Premium Tax Credits you are getting (the exact steps may differ between HealthCare.Gov and state exchanges).

You can take credits retroactively by filing form 8962 at the end of the year.

Since tax credit eligibly is based on annual MAGI (not AGI) it is smart to take them at the end of the year in a case where you are not sure of your income.

Out of pocket cost assistance on the other hand doesn't have to be paid back and can also be adjusted at any time. So in your case a smart move would be updating your projected income with the marketplace every X months (at the times when you project your income changing based on what is and has happened). This will allow you to qualify for more, less, or no out-of-pocket assistance and will affect the amount of advanced tax credits you are eligible to take. Again, even if you are eligible for advanced credits you may simply consider taking them at the end of the year when you are sure of your MAGI for that year.

If you take credits up front, and you make too much, you may have to repay advanced tax credits on form 8962 (you'll also use this form to claim tax credits).

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Freda on

Answer Rating:

If you buy your coverage through a broker does the same answer apply if you didn’t do it directly on the marketplace to be retroactive? on

If you bought a Marketplace plan through a broker then you can get cost assistance. If you bought a non-marketplace plan then you can’t. Same thing is true if you go direct to a provider. It’s currently open enrollment so make sure you get the right plan for you if you didn’t last time.

Kathy Nelson, CPA on

good information, easy read.

Vincent Craig on

I qualified for a subsidy based on an income that I estimated for 2016. I paid premiums in full each month from my savings hoping to get a tax refund at the end of the year. I had a bad year and show an AGI of 0.00 for 2016. Can I receive a refund equal or greater in subsidies for the premiums I paid in full out of savings?

Kay on

I did not apply last year for healthcare subsidies 2016 I see now end of 2017 that I probably would have qualified. I pay over 700.00 for a bronze plan is there anything I can do? Also what should I do about next year? on

Yes, you can take credits retroactively on form 8962 when you file taxes.

Sim on

We are in this exact situation. In 2016 went on the site, and based on our estimates we didn’t qualify for any subsidies. Being self employed, our income dropped in 2017 without a “qualifying event”. Now we are in the area of subsidy qualification for 2017. The plan we purchased from Kaiser is one that is IDENTICAL to the one we found on the marketplace, but we purchased it via Kaiser. Talking to coveredca now, they tell me since they don’t have an active “application” from us for 2017, there is no retroactive adjustment. I just don’t get this – they rejected me and told me I didn’t qualify. And the subsidy is federal, not state? Are we really SOL? Our $800 a month premiums for a bronze plan with $12K deductible will turn out to be about 20% of our gross income. on

This is one of the problems with the idea of selling on-exchange and off-exchange plans.

Qualified brokers and agents outside the marketplace CAN sign you up for a marketplace plan, but in some states they can also sell off-marketplace plans.

This can cause complications when people who make too much think they don’t need the marketplace, but then end up actually needing assistance due to life changes.

You can call Kaiser directly and ask them. If it is an on exchange plan, then perhaps there is some way to sign up for an account.

This is just one of the messy aspects of the ACA that is rather unnecessary and causes problems. They could fix this instead of pushing for repeals and tax cuts at the federal level. Really wish they would!

Gene Cowherd on

So if you didn’t get health insurance through the marketplace but still had a bad income year, you have no recourse? How can that be? on

You can get Medicaid… but yes, if you don’t get covered, and then have a bad year in terms of income, you have no recourse.

Why it is that way is a complex answer, but it has to do with open enrollment and the fact that if people could get covered whenever it would raise prices (as people would wait until they were sick).

You can always pick up a short term health plan, but they don’t offer assistance if Medicaid isn’t an option. When i doubt, contact and have them help you find a solution. There are some exemptions and such that might apply to depending on your specific situation.

Tammy on

I enrolled for healthcare through the marketplace for 2018, but wasn’t able to get subsidies because my employer offered a “minimal coverage” plan. I was laid off early in the year, and didn’t reapply for subsidies because I thought I’d get a job quickly (totally wrong–I’m still unemployed). Can I use form 8962 to retroactively get subsidies for the months I was unemployed? Or even for the whole year? It’d help a lot since my income was so low. on

You can retroactively get assistance for months you had marketplace coverage, but didn’t have access to employer coverage. So, essentially yes.