Do ACA Gold Plans Disqualify One from receiving the Premium Tax Credit?

[Laserjet3051]

Hi:

I've been searching and reading endlessly and cannot find an answer anywhere on this issue.

In the recent past, my modified AGI has been 402% of the FPL (federal poverty level) thus pushing me off the Obamacare cliff. I have no intention of continuing this and will immediately drop my mAGI to <400% FPL moving forward to qualify for the PTC (Premium Tax Credit).

But my question is, must I select a Silver (or Bronze) Plan on the Exchange to qualify for the PTC? I have had the Gold plan and want to continue with it but fear that I will learn, all too late, that Gold Plans are ineligible. Much of the language on PTC qualification at the IRS and Covered California describes things relative to the benchmark silver plan with zero discussion on Gold Plans.

I need to figure this out quickly before the impending deadline for health insurance plan selection on the CA Exchange. Your insight is greatly appreciated!

[secondcor521]

I believe gold plans qualify for ACA premium tax credits.

The way it works is that they take your AGI relative to the FPL and figure out how much you "should" be paying for health insurance.  They then look at the premium for the second cheapest silver plan in your zip code.  The difference is your premium tax credit.

But it is pretty clear you can take that tax credit and use it to purchase any metal level plan you want.

You of course would have to buy the plan via your ACA exchange in order to qualify for the PTC.

[seattlecyclone]

Yep, secondcor521 has it right.

The number of dollars you get to help pay your premium is a fixed amount based on your MAGI, family size, and cost of the second-cheapest silver plan in your area. You can use those dollars to reduce the cost of any plan on the exchange, regardless of metal level.

Do be aware that if you can bring your MAGI below 250% of the federal poverty level, you will likely qualify for cost sharing subsidies in addition to the premium subsidies. These cost sharing subsidies are only applicable to silver plans, but they have the effect of making the silver plan's coverage better than normal. Between 200-250% of the poverty level the effect isn't huge, but below 200% you effectively get a platinum plan for the price of a silver plan.