IRS Proposes Clarifications to Benchmark ACA Calculations

The IRS issued a notice of proposed rulemaking (NPRM) that would provide technical clarifications across a range of issues affecting individuals’ eligibility for and amount of ACA premium tax credits, including how benchmark plan premiums are calculated. Notably, the regulations would ensure that benchmark plan premiums, which help determine the amount of premium tax credit for which an individual is eligible, include the cost of pediatric dental benefits, which currently are sometimes not included in the benchmark plan. This would effectively increase the amount of premium tax credit for which an impacted consumer may be eligible. The proposed rules would also provide additional leeway for individuals transitioning from Marketplace coverage with tax credits to Medicaid or CHIP. If a Marketplace is delayed in terminating tax credits leading to an extra month of dual enrollment, enrollees would not owe back the tax credits for that month. The rule also addresses how to calculate the affordability of employer-sponsored insurance and how to conduct the reconciliation of advance premium tax credits in some special cases. If finalized, much of the rule would be effective for the 2017 tax year, though changes to benchmark plan premium calculations would generally take effect in the 2019 tax year and certain provisions that expand eligibility for premium tax credits would apply retroactively to the 2014 tax year.

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