Requiring Verification of Eligibility for Premium Tax Credit
Section 71303 · Sec. 71303 ·
What this chapter is about
This part makes an exchange verify eligibility before a month counts for the credit. It must check income, family size, status and where the person lives. An exchange must also offer a pre-signup check from August 1. It starts with tax years after December 31, 2027.
The document says “shall not”Who acts: Secretary of the TreasuryHow: statuteSec. 71303 in the PDF
What the document says
“The term `coverage month' shall not include, with respect to any individual covered by a qualified health plan enrolled in through an Exchange, any month beginning before the Exchange verifies, using applicable enrollment information that shall be provided or verified by the applicant, such individual's eligibility--”
The section adds a new paragraph (5) to section 36B(c) of the Internal Revenue Code of 1986 so that a month before the Exchange verifies the person's eligibility to enrol and for any advance payment does not count as a coverage month. A month that begins before verification still counts if the Exchange later verifies eligibility for that month.
What the document actually says
“The term `coverage month' shall not include, with respect to any individual covered by a qualified health plan enrolled in through an Exchange, any month beginning before the Exchange verifies, using applicable enrollment information that shall be provided or verified by the applicant, such individual's eligibility--”
That sentence, in plain words
A month does not count until the exchange checks. It must check that the person could sign up. It must also check they qualify for advance help.
What this is about
The applicant must give or confirm the information. A past month can still count. It counts once the exchange checks it.
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“applicable enrollment information shall include affirmation of at least the following information (to the extent relevant in determining eligibility described in subparagraph (A)):”
The section requires the information to include at least household income and family size, whether the person is an eligible alien, any health coverage status or eligibility, place of residence, and anything else the Secretary determines is needed, in consultation with the Secretary of Health and Human Services. A person is not treated as ineligible to enrol just for failing the requirement, the Secretary may waive it for a special enrollment period based on a change in family size, and the Exchange may use data it holds and reliable third-party sources.
What the document actually says
“applicable enrollment information shall include affirmation of at least the following information (to the extent relevant in determining eligibility described in subparagraph (A)):”
That sentence, in plain words
The information must cover the things listed below. It must be affirmed by the applicant.
What this is about
It covers what the home earns and how big it is. It covers status and any other cover held. It covers where the person lives.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“Such term shall not include any plan enrolled in through an Exchange, unless such Exchange provides a process for pre-enrollment verification through which any applicant may, beginning not later than August 1, verify with the Exchange the applicant's household income and eligibility for enrollment in such plan for plan years beginning in the subsequent year.”
The section adds a new clause to section 36B(c)(3)(A) of the Internal Revenue Code of 1986 so that a plan bought through an Exchange does not count unless the Exchange offers a process, open from August 1 at the latest, by which any applicant may verify household income and eligibility for the next plan year. It also bars a month where the Exchange fails a named filing requirement in title 45 of the Code of Federal Regulations. The amendments apply to taxable years beginning after December 31, 2027.
What the document actually says
“Such term shall not include any plan enrolled in through an Exchange, unless such Exchange provides a process for pre-enrollment verification through which any applicant may, beginning not later than August 1, verify with the Exchange the applicant's household income and eligibility for enrollment in such plan for plan years beginning in the subsequent year.”
That sentence, in plain words
A plan does not count unless the exchange offers a check before signup. That must be open by August 1 at the latest.
What this is about
The applicant may check income and eligibility. It covers the plan year starting the next year. The changes start with tax years after 2027.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
Each distinct thing the section does: bar a coverage month before verification, list the information to be affirmed, allow past months to count once verified, keep the person enrolled despite a failure, allow a waiver for a family size special enrollment period, allow third-party data, bar a month where the Exchange misses a filing rule, require a pre-enrollment verification process, and fix the effective date.
Nothing in the section is left out. It has three subsections and each is recorded.
The section works by amending section 36B(c) of the Internal Revenue Code of 1986 and points to section 1412 of the Patient Protection and Affordable Care Act and a regulation in title 45 of the Code of Federal Regulations, none of which is indexed here.
