NAVIGATING OPEN ENROLLMENT: Healthcare.gov Income Questions

Need to enroll in a health insurance policy or update the one you have?

Open Enrollment for the Health Insurance Marketplace (Healthcare.gov) is Nov. 1, 2021, to Jan. 15, 2022.

Charlotte Center for Legal Advocacy’s health insurance navigators help families and individuals choose plans that are best for them within the Health Insurance Marketplace implemented under the Affordable Care Act (ACA). During this Open Enrollment Period, navigators have received calls and questions from Cabarrus, Mecklenburg and Union County residents about the household income section of the Healthcare.gov application. With this year’s pandemic and economic uncertainty, many have lost or changed employment and are struggling to estimate their income.

Listed below are some helpful tips and general guidelines. More of what to (and not to) include is available at charlottelegaladvocacy.org/getcovered.

Important points:

  • You must estimate your projected income for the upcoming year.
    • If you are unemployed, it may be difficult to do this. Estimate how much you would make if you returned to your previous job.
    • If you don’t have a set salary or wages (for example, if you are a freelance worker, seasonal worker, or run your own business), it will be easier to estimate your income if you have a copy of your tax return from last year on hand.
    • If you are self-employed, you should input your net income. Click here for more help estimating your self-employment income.
    • If your income is very low or if you are unemployed, and you or a family member falls into one of the following groups, you may qualify to receive Medicaid: children under 21, pregnant women, women with breast or cervical cancer, individuals age 65 or older, blind or disabled individuals, people in need of long-term care, or people receiving Medicare.
  • You must report changes in income.
    • During the year, you must go back into your application to report if your income goes up or down. This will keep your monthly premium at a manageable price and help to reduce the amount of financial assistance you may have to pay back, if any at all.
  • You can receive financial assistance.
    • Estimating your income as accurately as possible allows the Marketplace to determine your eligibility for financial assistance.

Be sure to include:

  • Anticipated changes in income
    • Consider these questions: How might your income change in the coming year? Are you expecting business to improve or worsen? Will you be getting a raise? Work more hours? Get a seasonal job? Will another household member get a job? Will you gain or lose a dependent?
  • The anticipated income of all household members
    • If another person in your tax household has health coverage through a different plan or program, you still need to include their income on your application. Marketplace financial assistance is based on the income of all tax household members. You will be able to clarify on the application which household members do not need health coverage. Tax household members not applying for coverage are not required to provide any other information except income information (e.g. They do not have to provide a Social Security Number).
  • Some disability-related income
    • Only include Social Security disability payments when estimating your income for next year. Do not include Supplemental Security Income, only Social Security retirement or disability payments.
  • Income from investments
    • Things like stocks and bonds.
  • Alimony
    • Include only if your divorce or separation was finalized before January 1, 2019.

Do NOT include:

  • Self-employment expenses
    • Subtract any self-employment expenses from your estimated income.
  • Some disability-related income
    • Do not include Veterans’ disability income payments, Supplemental Security Income (SSI) payments, and workers’ compensation payments when estimating your income for next year.
  • Social Security payments for applications that have not yet be approved
    • You can update your Marketplace application later next year if your application is approved.
  • Alimony
    • Do not include if your divorce or separation was finalized on or after January 1, 2019.
  • Child support

Free appointments with a local navigator can be made using the statewide appointment hotline at 1-855-733-3711, or online at www.ncnavigator.net. Appointments are filling quickly!

More Resources:

More information on how to report your income: https://www.healthcare.gov/income-and-household-information/how-to-report/

And on what to include: https://www.healthcare.gov/income-and-household-information/income/