26 U.S.C. § 36B
Refundable credit for coverage under a qualified health plan
In the case of an applicable taxpayer, there shall be allowed as a credit against the tax imposed by this subtitle for any taxable year an amount equal to the premium assistance credit amount of the taxpayer for the taxable year.
The term “premium assistance credit amount” means, with respect to any taxable year, the sum of the premium assistance amounts determined under paragraph (2) with respect to all coverage months of the taxpayer occurring during the taxable year.
Except as provided in clause (ii), the applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier:
In the case of household income (expressed as a percent of poverty line) within the following income tier: | The initial premium percentage is— | The final premium percentage is— |
|---|---|---|
Up to 133% | 2.0% | 2.0% |
133% up to 150% | 3.0% | 4.0% |
150% up to 200% | 4.0% | 6.3% |
200% up to 250% | 6.3% | 8.05% |
250% up to 300% | 8.05% | 9.5% |
300% up to 400% | 9.5% | 9.5%. |
Subject to subclause (II), in the case of taxable years beginning in any calendar year after 2014, the initial and final applicable percentages under clause (i) (as in effect for the preceding calendar year after application of this clause) shall be adjusted to reflect the excess of the rate of premium growth for the preceding calendar year over the rate of income growth for the preceding calendar year.
Except as provided in subclause (III), in the case of any calendar year after 2018, the percentages described in subclause (I) shall, in addition to the adjustment under subclause (I), be adjusted to reflect the excess (if any) of the rate of premium growth estimated under subclause (I) for the preceding calendar year over the rate of growth in the consumer price index for the preceding calendar year.
Subclause (II) shall apply for any calendar year only if the aggregate amount of premium tax credits under this section and cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act for the preceding calendar year exceeds an amount equal to 0.504 percent of the gross domestic product for the preceding calendar year.
In the case of household income (expressed as a percent of poverty line) within the following income tier: | The initial premium percentage is— | The final premium percentage is— |
|---|---|---|
Up to 150.0 percent | 0.0 | 0.0 |
150.0 percent up to 200.0 percent | 0.0 | 2.0 |
200.0 percent up to 250.0 percent | 2.0 | 4.0 |
250.0 percent up to 300.0 percent | 4.0 | 6.0 |
300.0 percent up to 400.0 percent | 6.0 | 8.5 |
400.0 percent and higher | 8.5 | 8.5 |
The adjusted monthly premium for an applicable second lowest cost silver plan is the monthly premium which would have been charged (for the rating area with respect to which the premiums under paragraph (2)(A) were determined) for the plan if each individual covered under a qualified health plan taken into account under paragraph (2)(A) were covered by such silver plan and the premium was adjusted only for the age of each such individual in the manner allowed under section 2701 of the Public Health Service Act. In the case of a State participating in the wellness discount demonstration project under section 2705(d) of the Public Health Service Act, the adjusted monthly premium shall be determined without regard to any premium discount or rebate under such project.
For purposes of determining the amount of any monthly premium, if an individual enrolls in both a qualified health plan and a plan described in section 1311(d)(2)(B)(ii)(I) 2 of the Patient Protection and Affordable Care Act for any plan year, the portion of the premium for the plan described in such section that (under regulations prescribed by the Secretary) is properly allocable to pediatric dental benefits which are included in the essential health benefits required to be provided by a qualified health plan under section 1302(b)(1)(J) of such Act shall be treated as a premium payable for a qualified health plan.
The term “applicable taxpayer” means, with respect to any taxable year, a taxpayer whose household income for the taxable year equals or exceeds 100 percent but does not exceed 400 percent of an amount equal to the poverty line for a family of the size involved.
If the taxpayer is married (within the meaning of section 7703) at the close of the taxable year, the taxpayer shall be treated as an applicable taxpayer only if the taxpayer and the taxpayer’s spouse file a joint return for the taxable year.
No credit shall be allowed under this section to any individual with respect to whom a deduction under section 151 is allowable to another taxpayer for a taxable year beginning in the calendar year in which such individual’s taxable year begins.
In the case of a taxable year beginning after
The term “coverage month” shall not include any month with respect to an individual if for such month the individual is eligible for minimum essential coverage other than eligibility for coverage described in section 5000A(f)(1)(C) (relating to coverage in the individual market).
The term “minimum essential coverage” has the meaning given such term by section 5000A(f).
Except as provided in clause (iii), an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) and the plan’s share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs.
Clauses (i) and (ii) shall not apply if the employee (or any individual described in the last sentence of clause (i)) is covered under the eligible employer-sponsored plan or the grandfathered health plan.
In the case of plan years beginning in any calendar year after 2014, the Secretary shall adjust the 9.5 percent under clause (i)(II) in the same manner as the percentages are adjusted under subsection (b)(3)(A)(ii).
The term “qualified health plan” has the meaning given such term by section 1301(a) of the Patient Protection and Affordable Care Act, except that such term shall not include a qualified health plan which is a catastrophic plan described in section 1302(e) of such Act.
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 term “grandfathered health plan” has the meaning given such term by section 1251 of the Patient Protection and Affordable Care Act.
The term “coverage month” shall not include any month with respect to an employee (or any spouse or dependent of such employee) if for such month the employee is provided a qualified small employer health reimbursement arrangement which constitutes affordable coverage.
In the case of any employee who is provided a qualified small employer health reimbursement arrangement for any coverage month (determined without regard to subparagraph (A)), the credit otherwise allowable under subsection (a) to the taxpayer for such month shall be reduced (but not below zero) by the amount described in subparagraph (C)(i)(II) for such month.
For purposes of this paragraph, the term “qualified small employer health reimbursement arrangement” has the meaning given such term by section 9831(d)(2).
In the case of an employee who is provided a qualified small employer health reimbursement arrangement for less than an entire year, subparagraph (C)(i)(II) shall be applied by substituting “the number of months during the year for which such arrangement was provided” for “12”.
In the case of plan years beginning in any calendar year after 2014, the Secretary shall adjust the 9.5 percent amount under subparagraph (C)(ii) in the same manner as the percentages are adjusted under subsection (b)(3)(A)(ii).
The family size involved with respect to any taxpayer shall be equal to the number of individuals for whom the taxpayer is allowed a deduction under section 151 (relating to allowance of deduction for personal exemptions) for the taxable year.
The term “poverty line” has the meaning given that term in section 2110(c)(5) of the Social Security Act (42 U.S.C. 1397jj(c)(5)).
In the case of any qualified health plan offered through an Exchange for coverage during a taxable year beginning in a calendar year, the poverty line used shall be the most recently published poverty line as of the 1st day of the regular enrollment period for coverage during such calendar year.
For purposes of this section, an individual shall be treated as lawfully present only if the individual is, and is reasonably expected to be for the entire period of enrollment for which the credit under this section is being claimed, a citizen or national of the United States or an alien lawfully present in the United States.
The Secretary of Health and Human Services, in consultation with the Secretary, shall prescribe rules setting forth the methods by which calculations of family size and household income are made for purposes of this subsection. Such rules shall be designed to ensure that the least burden is placed on individuals enrolling in qualified health plans through an Exchange and taxpayers eligible for the credit allowable under this section.
The amount of the credit allowed under this section for any taxable year shall be reduced (but not below zero) by the amount of any advance payment of such credit under section 1412 of the Patient Protection and Affordable Care Act.
If the advance payments to a taxpayer under section 1412 of the Patient Protection and Affordable Care Act for a taxable year exceed the credit allowed by this section (determined without regard to paragraph (1)), the tax imposed by this chapter for the taxable year shall be increased by the amount of such excess.
For purposes of this subsection, the term “unemployment compensation” has the meaning given such term in section 85(b).
For purposes of this subsection, a taxpayer shall not be treated as having received (or been approved to receive) unemployment compensation for any week unless such taxpayer provides self-attestation of, and such documentation as the Secretary shall prescribe which demonstrates, such receipt or approval.
Paragraph (1)(A) shall not affect the application of subsection (c)(1)(C).
Paragraph (1)(B) shall not apply to any determination of household income for purposes of paragraph (2)(C)(i)(II) or (4)(C)(ii) of subsection (c) 5
Pub. L. 119–21, title VII, § 71303(b), (c),
(1) by striking “health plan.—The term” and inserting “health plan
“(i) In general
“The term”, and
(2) by adding at the end the following new clause:
“(ii) Pre-enrollment verification process required
“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.”
See 2025 Amendment notes below.
Pub. L. 119–21, title VII, § 71303(a), (c),
“(5) Exchange enrollment verification requirement
“(A) In general
“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—
“(i) to enroll in the plan through the Exchange, and
“(ii) for any advance payment under section 1412 of the Patient Protection and Affordable Care Act of the credit allowed under this section.
“(B) Applicable enrollment information
“For purposes of subparagraph (A), applicable enrollment information shall include affirmation of at least the following information (to the extent relevant in determining eligibility described in subparagraph (A)):
“(i) Household income and family size.
“(ii) Whether the individual is an eligible alien.
“(iii) Any health coverage status or eligibility for coverage.
“(iv) Place of residence.
“(v) Such other information as may be determined by the Secretary (in consultation with the Secretary of Health and Human Services) as necessary to the verification prescribed under subparagraph (A).
“(C) Verification of past months
“In the case of a month that begins before verification prescribed by subparagraph (A), such month shall be treated as a coverage month if the Exchange verifies for such month (using applicable enrollment information that shall be provided or verified by the applicant) such individual’s eligibility to have so enrolled and for any such advance payment.
“(D) Exchange participation; coordination with other procedures for determining eligibility
“An individual shall not, solely by reason of failing to meet the requirements of this paragraph with respect to a month, be treated for such month as ineligible to enroll in a qualified health plan through an Exchange.
“(E) Waiver for certain special enrollment periods
“The Secretary may waive the application of subparagraph (A) in the case of an individual who enrolls in a qualified health plan through an Exchange for 1 or more months of the taxable year during a special enrollment period provided by the Exchange on the basis of a change in the family size of the individual.
“(F) Information and reliance on third-party sources
“An Exchange shall be permitted to use any data available to the Exchange and any reliable third-party sources in collecting information for verification by the applicant.
“(6) Exchange compliance with filing requirements
“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 for which the Exchange does not meet the requirements of section 155.305(f)(4)(iii) of title 45, Code of Federal Regulations (as published in the Federal Register on
See 2025 Amendment notes below.
Pub. L. 119–21, title VII, § 71301(a), (b), (e),
(1) in paragraph (1), by inserting “or, in the case of aliens who are lawfully present, are not eligible aliens” after “individuals who are not lawfully present”; and
(2) in paragraph (2):
(A) by striking “For purposes of this section, an individual” and inserting “For purposes of this section—
“(A) In general
“An individual”; and
(B) by adding at the end the following new subparagraph:
“(B) Eligible aliens
“An individual who is an alien and lawfully present shall be treated as an eligible alien if such individual is, and is reasonably expected to be for the entire period of enrollment for which the credit under this section is being claimed—
“(i) an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act (8 U.S.C. 1101 et seq.),
“(ii) an alien who has been granted the status of Cuban and Haitian entrant, as defined in section 501(e) of the Refugee Education Assistance Act of 1980 (Public Law 96–422); or
“(iii) an individual who lawfully resides in the United States in accordance with a Compact of Free Association referred to in section 402(b)(2)(G) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2)(G)).”
See 2025 Amendment notes below.
For inflation adjustment of certain items in this section, see Revenue Procedures listed in a table under section 1 of this title.
Sections 1251, 1301, 1302, 1311, 1321, 1402, and 1412 of the Patient Protection and Affordable Care Act, referred to in text, are classified to sections 18011, 18021, 18022, 18031, 18041, 18071, and 18082, respectively, of Title 42, The Public Health and Welfare.
Section 1(c), referred to in subsecs. (b)(3)(B)(ii)(I)(aa) and (f)(2)(B)(i), to be treated, for purposes of the rate of tax, as a reference to the corresponding rate bracket under section 1(j)(2)(C) of this title, see section 1(j)(2)(F) of this title.
Sections 2701 and 2705(d) of the Public Health Service Act, referred to in subsec. (b)(3)(C), are classified to sections 300gg and 300gg–4(d), respectively, of Title 42, The Public Health and Welfare. The reference to section 2705(d) probably should be a reference to section 2705(l), which relates to wellness program demonstration project and is classified to section 300gg–4(l) of Title 42.
Section 1311(d)(2)(B)(ii)(I) of the Patient Protection and Affordable Care Act, referred to in subsec. (b)(3)(E), probably means section 1311(d)(2)(B)(ii) of Pub. L. 111–148, which is classified to section 18031(d)(2)(B)(ii) of Title 42, The Public Health and Welfare, and which does not contain subclauses.
The Social Security Act, referred to in subsec. (c)(1)(B)(ii), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XIX of the Act is classified generally to subchapter XIX (§ 1396 et seq.) of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.
2025—Subsec. (c)(1)(B). Pub. L. 119–21, § 71302(a), struck out subpar. (B) which related to a special rule for certain individuals lawfully present in the United States for treatment as an applicable taxpayer.
Subsec. (c)(3)(A). Pub. L. 119–21, § 71303(b), designated existing provisions as cl. (i), inserted heading, and added cl. (ii).
Subsec. (c)(3)(A)(iii). Pub. L. 119–21, § 71304(a), added cl. (iii).
Subsec. (c)(5), (6). Pub. L. 119–21, § 71303(a), added pars. (5) and (6).
Subsec. (e)(1). Pub. L. 119–21, § 71301(a), inserted “or, in the case of aliens who are lawfully present, are not eligible aliens” after “individuals who are not lawfully present” in introductory provisions.
Subsec. (e)(2). Pub. L. 119–21, § 71301(b), substituted “For purposes of this section—” for “For purposes of this section,”, designated remainder of existing provisions as subpar. (A), inserted heading, and added subpar. (B).
Subsec. (f)(2). Pub. L. 119–21, § 71305(a), (b)(1), struck out subpar. (A) designation and heading and subpar. (B) which related to limitation on increase of advance payments under section 1412 of the Patient Protection and Affordable Care Act to a taxpayer whose household income is less than 400 percent of the poverty line for the size of the family involved for the taxable year.
2022—Subsec. (b)(3)(A)(iii). Pub. L. 117–169, § 12001(a), substituted “2021 through 2025” for “2021 and 2022” in heading and “after
Subsec. (c)(1)(E). Pub. L. 117–169, § 12001(b), substituted “2021 through 2025” for “2021 and 2022” in heading and “after
2021—Subsec. (b)(3)(A)(iii). Pub. L. 117–2, § 9661(a), added cl. (iii).
Subsec. (c)(1)(E). Pub. L. 117–2, § 9661(b), added subpar. (E).
Subsec. (f)(2)(B)(iii). Pub. L. 117–2, § 9662(a), added cl. (iii).
Subsecs. (g), (h). Pub. L. 117–2, § 9663(a), added subsec. (g) and redesignated former subsec. (g) as (h).
2017—Subsec. (f)(2)(B)(ii)(II). Pub. L. 115–97 substituted “for ‘calendar year 2016’ in subparagraph (A)(ii)” for “for ‘calendar year 1992’ in subparagraph (B)”.
2016—Subsec. (c)(4). Pub. L. 114–255 added par. (4).
2011—Subsec. (c)(2)(D). Pub. L. 112–10 struck out subpar. (D). Prior to amendment, text read as follows: “The term ‘coverage month’ shall not include any month in which such individual has a free choice voucher provided under section 10108 of the Patient Protection and Affordable Care Act.”
Subsec. (d)(2)(B)(iii). Pub. L. 112–56 added cl. (iii).
Subsec. (f)(2)(B)(i). Pub. L. 112–9 amended cl. (i) generally. Prior to amendment, cl. (i) consisted of text and a table limiting increase in amount recovered on reconciliation of health insurance tax credit and advance of that credit for households with income below 500 percent of Federal poverty line.
2010—Subsec. (b)(3)(A)(i). Pub. L. 111–152, § 1001(a)(1)(A), substituted “for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier:” for “with respect to any taxpayer for any taxable year is equal to 2.8 percent, increased by the number of percentage points (not greater than 7) which bears the same ratio to 7 percentage points as—” in introductory provisions, inserted table, and struck out subcls. (I) and (II) which read as follows:
“(I) the taxpayer’s household income for the taxable year in excess of 100 percent of the poverty line for a family of the size involved, bears to
“(II) an amount equal to 200 percent of the poverty line for a family of the size involved.”
Subsec. (b)(3)(A)(ii). Pub. L. 111–152, § 1001(a)(1)(B), added cl. (ii) and struck out former cl. (ii). Text read as follows: “If a taxpayer’s household income for the taxable year equals or exceeds 100 percent, but not more than 133 percent, of the poverty line for a family of the size involved, the taxpayer’s applicable percentage shall be 2 percent.”
Pub. L. 111–148, § 10105(a), substituted “equals or exceeds” for “is in excess of”.
Subsec. (b)(3)(A)(iii). Pub. L. 111–152, § 1001(a)(1)(B), struck out cl. (iii). Text read as follows: “In the case of taxable years beginning in any calendar year after 2014, the Secretary shall adjust the initial and final applicable percentages under clause (i), and the 2 percent under clause (ii), for the calendar year to reflect the excess of the rate of premium growth between the preceding calendar year and 2013 over the rate of income growth for such period.”
Subsec. (c)(1)(A). Pub. L. 111–148, § 10105(b), inserted “equals or” before “exceeds”.
Subsec. (c)(2)(C)(i)(II). Pub. L. 111–152, § 1001(a)(2)(A), substituted “9.5 percent” for “9.8 percent”.
Subsec. (c)(2)(C)(iv). Pub. L. 111–152, § 1001(a)(2), substituted “9.5 percent” for “9.8 percent” and “(b)(3)(A)(ii)” for “(b)(3)(A)(iii)”.
Pub. L. 111–148, § 10105(c), substituted “subsection (b)(3)(A)(iii)” for “subsection (b)(3)(A)(ii)”.
Subsec. (c)(2)(D). Pub. L. 111–148, § 10108(h)(1), added subpar. (D).
Subsec. (d)(2)(A)(i), (ii). Pub. L. 111–152, § 1004(a)(1)(A), substituted “modified adjusted gross” for “modified gross”.
Subsec. (d)(2)(B). Pub. L. 111–152, § 1004(a)(2)(A), amended subpar. (B) generally. Prior to amendment, text read as follows: “The term ‘modified gross income’ means gross income—
“(i) decreased by the amount of any deduction allowable under paragraph (1), (3), (4), or (10) of section 62(a),
“(ii) increased by the amount of interest received or accrued during the taxable year which is exempt from tax imposed by this chapter, and
“(iii) determined without regard to sections 911, 931, and 933.”
Subsec. (f)(2)(B). Pub. L. 111–309, § 208(a), amended generally subpar. heading and cl. (i). Prior to amendment, text of cl. (i) read as follows: “In the case of an applicable taxpayer whose household income is less than 400 percent of the poverty line for the size of the family involved for the taxable year, the amount of the increase under subparagraph (A) shall in no event exceed $400 ($250 in the case of a taxpayer whose tax is determined under section 1(c) for the taxable year).”
Subsec. (f)(2)(B)(ii). Pub. L. 111–309, § 208(b), inserted “in the table contained” after “each of the dollar amounts” in introductory provisions.
Subsec. (f)(3). Pub. L. 111–152, § 1004(c), added par. (3).
Pub. L. 119–21, title VII, § 71301(e),
Pub. L. 119–21, title VII, § 71302(b),
Pub. L. 119–21, title VII, § 71303(c),
Pub. L. 119–21, title VII, § 71304(b),
Amendment by section 71305 of Pub. L. 119–21, applicable to taxable years beginning after
Pub. L. 117–169, title I, § 12001(c),
Pub. L. 117–2, title IX, § 9661(c),
Pub. L. 117–2, title IX, § 9662(b),
Pub. L. 117–2, title IX, § 9663(b),
Amendment by Pub. L. 115–97 applicable to taxable years beginning after
Pub. L. 114–255, div. C, title XVIII, § 18001(a)(7),
Pub. L. 112–56, title IV, § 401(b),
Pub. L. 112–10, div. B, title VIII, § 1858(d),
Pub. L. 112–9, § 4(b),
Pub. L. 111–309, title II, § 208(c),
Pub. L. 111–148, title X, § 10108(h)(2),
Pub. L. 111–148, title I, § 1401(e),
Pub. L. 114–255, div. C, title XVIII, § 18001(a)(8),
Pub. L. 112–56, title IV, § 401(c),