ACA Tax Credits: What Proof Do You Need to Send to the Marketplace?

After enrolling in Marketplace health insurance, it’s essential to be aware of the potential need to submit documentation to the Marketplace to verify certain information you provided on your application. These documents could be related to your household income or proof of citizenship. Failure to submit the necessary documentation within the specified timeframe can result in the loss of your tax credits and increased monthly premiums.

What is the Eligibility Determination Notice (EDN)?
Upon enrollment, you should have received an Eligibility Determination Notice (EDN) from the Marketplace. This document will outline what you are eligible for, such as a specific plan and the amount of tax credits you qualify for. It also indicates if the Marketplace requires any additional information to verify your eligibility.

What to Look for on Your EDN
Review the EDN carefully to check for the “If” column in the eligibility determination box. This column will state whether or not the Marketplace needs proof of any information you provided on your application and the deadline for submitting it. It’s important to note that not everyone is required to submit documents.

Missing the Deadline
If you fail to meet the deadline for submitting the requested documentation, the Marketplace will typically send you a notice informing you that you have lost the tax credits or other benefits granted in the EDN, effective the first of the following month. Seeking professional help from a licensed insurance agent as soon as possible is recommended in such cases. They can guide you through the process of filing an appeal or exploring alternative options to maintain your coverage.

Importance of Reconciling Tax Credits
In addition to submitting documentation, it’s also crucial to reconcile your tax credits annually. This means comparing the estimated tax credits you received throughout the year with the actual amount you are eligible for based on your income and tax filing status. If you received more tax credits than you should have, you may need to repay the excess amount. On the other hand, if you qualified for more tax credits than you received, you can claim the difference on your tax return.

By understanding the requirements for submitting documentation and reconciling tax credits, you can ensure that you maintain your eligibility for Marketplace health insurance and maximize your financial assistance.