United States Code

42 U.S.C. § 18082

Advance determination and payment of premium tax credits and cost-sharing reductions

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Bills that would change it 36

  • HR 6575 CommonGround for Affordable Health Care Act Amends 18082(c)(2) · introduced · 119th Congress
  • S 3389 Lowering Health Care Costs for Americans Act Amends · introduced · 119th Congress
  • HR 6501 Bipartisan Health Insurance Affordability Act Amends 18082(c)(2) · introduced · 119th Congress
  • HR 6512 Putting Patients First Healthcare Freedom Act Amends 18082(b) · introduced · 119th Congress
  • HR 6232 HOPE Act Amends 18082(c)(2) · introduced · 119th Congress
  • HRES 902 Providing for consideration of the bill (H.R. 185) to advance responsible policies. Amends 18082(c)(2) · introduced · 119th Congress
  • HR 1 An act to provide for reconciliation pursuant to title II of H. Con. Res. 14. Amends 18082(d) · enacted · 119th Congress
  • HR 4104 Health Equity and Access under the Law for Immigrant Families Act of 2025 Amends · introduced · 119th Congress
  • S 2149 Health Equity and Access under the Law for Immigrant Families Act of 2025 Amends · introduced · 119th Congress
  • HR 3947 Easy Enrollment in Health Care Act Amends 18082(b) · introduced · 119th Congress
  • S 2057 Easy Enrollment in Health Care Act Amends 18082(b) · introduced · 119th Congress
  • HR 746 America First Act Amends · introduced · 119th Congress
  • S 62 America First Act Amends · introduced · 119th Congress
  • HR 5008 HEAL for Immigrant Families Act of 2023 Amends · introduced · 118th Congress
  • HR 1113 Easy Enrollment in Health Care Act Amends 18082(b) · introduced · 118th Congress
  • HR 4303 Abortion Justice Act of 2023 Amends · introduced · 118th Congress
  • S 2646 HEAL for Immigrant Families Act of 2023 Amends · introduced · 118th Congress
  • S 423 Easy Enrollment in Health Care Act Amends 18082(b) · introduced · 118th Congress
  • HR 7585 Health Equity and Accountability Act of 2022 Amends · introduced · 117th Congress
  • S 4486 Health Equity and Accountability Act of 2022 Amends · introduced · 117th Congress
  • HR 5610 Easy Enrollment in Health Care Act Amends 18082(b) · introduced · 117th Congress
  • S 3001 Easy Enrollment in Health Care Act Amends 18082(b) · introduced · 117th Congress
  • S 1660 HEAL for Immigrant Families Act of 2021 Amends · introduced · 117th Congress
  • HR 3149 HEAL for Immigrant Families Act of 2021 Amends · introduced · 117th Congress
  • HR 689 Premium Relief Act of 2021 Amends 18082(c)(2) · introduced · 117th Congress
  • HR 1425 Patient Protection and Affordable Care Enhancement Act Amends 18082(d) · introduced · 116th Congress
  • HR 4701 HEAL for Immigrant Women and Families Act of 2019 Amends · introduced · 116th Congress
  • HR 2469 Health Coverage State Flexibility Act of 2019 Amends 18082(c)(2) · introduced · 116th Congress
  • HR 1510 Premium Relief Act of 2019 Amends 18082(c)(2) · introduced · 116th Congress
  • HR 5942 Health Equity and Accountability Act of 2018 Amends · introduced · 115th Congress
  • HJRES 124 Making further additional continuing appropriations for fiscal year 2018, and for other purposes. Amends 18082(c) · introduced · 115th Congress
  • HR 3922 CHAMPIONING HEALTHY KIDS Act Amends 18082(c) · introduced · 115th Congress
  • HR 1933 Health Care Options Act of 2017 Amends · introduced · 115th Congress
  • S 761 Health Care Options Act of 2017 Amends · introduced · 115th Congress
  • HR 1435 Exchange Inclusion for a Healthy America Act of 2017 Amends · introduced · 115th Congress
  • HR 710 Health Coverage State Flexibility Act of 2017 Amends 18082(c)(2) · introduced · 115th Congress

The law today

From the official United States Code, current through Public Law 119-121.

(a) In general The Secretary, in consultation with the Secretary of the Treasury, shall establish a program under which— (1) upon request of an Exchange, advance determinations are made under section 18081 of this title with respect to the income eligibility of individuals enrolling in a qualified health plan in the individual market through the Exchange for the premium tax credit allowable under section 36B of title 26 and the cost-sharing reductions under section 18071 of this title; (2) the Secretary notifies— (A) the Exchange and the Secretary of the Treasury of the advance determinations; and (B) the Secretary of the Treasury of the name and employer identification number of each employer with respect to whom 1 or more employee 1 of the employer were determined to be eligible for the premium tax credit under section 36B of title 26 and the cost-sharing reductions under section 18071 of this title because— (i) the employer did not provide minimum essential coverage; or (ii) the employer provided such minimum essential coverage but it was determined under section 36B(c)(2)(C) of title 26 to either be unaffordable to the employee or not provide the required minimum actuarial value; and (3) the Secretary of the Treasury makes advance payments of such credit or reductions to the issuers of the qualified health plans in order to reduce the premiums payable by individuals eligible for such credit. (b) Advance determinations (1) In general The Secretary shall provide under the program established under subsection (a) that advance determination of eligibility with respect to any individual shall be made— (A) during the annual open enrollment period applicable to the individual (or such other enrollment period as may be specified by the Secretary); and (B) on the basis of the individual’s household income for the most recent taxable year for which the Secretary, after consultation with the Secretary of the Treasury, determines information is available. (2) Changes in circumstances The Secretary shall provide procedures for making advance determinations on the basis of information other than that described in paragraph (1)(B) in cases where information included with an application form demonstrates substantial changes in income, changes in family size or other household circumstances, change in filing status, the filing of an application for unemployment benefits, or other significant changes affecting eligibility, including— (A) allowing an individual claiming a decrease of 20 percent or more in income, or filing an application for unemployment benefits, to have eligibility for the credit determined on the basis of household income for a later period or on the basis of the individual’s estimate of such income for the taxable year; and (B) the determination of household income in cases where the taxpayer was not required to file a return of tax imposed by this chapter for the second preceding taxable year. (c) Payment of premium tax credits and cost-sharing reductions (1) In general The Secretary shall notify the Secretary of the Treasury and the Exchange through which the individual is enrolling of the advance determination under section 18081 of this title. (2) Premium tax credit (A) In general The Secretary of the Treasury shall make the advance payment under this section of any premium tax credit allowed under section 36B of title 26 to the issuer of a qualified health plan on a monthly basis (or such other periodic basis as the Secretary may provide). (B) Issuer responsibilities An issuer of a qualified health plan receiving an advance payment with respect to an individual enrolled in the plan shall— (i) reduce the premium charged the insured for any period by the amount of the advance payment for the period; (ii) notify the Exchange and the Secretary of such reduction; (iii) include with each billing statement the amount by which the premium for the plan has been reduced by reason of the advance payment; and (iv) in the case of any nonpayment of premiums by the insured— (I) notify the Secretary of such nonpayment; and (II) allow a 3-month grace period for nonpayment of premiums before discontinuing coverage. (3) Cost-sharing reductions The Secretary shall also notify the Secretary of the Treasury and the Exchange under paragraph (1) if an advance payment of the cost-sharing reductions under section 18071 of this title is to be made to the issuer of any qualified health plan with respect to any individual enrolled in the plan. The Secretary of the Treasury shall make such advance payment at such time and in such amount as the Secretary specifies in the notice. (d) No Federal payments for individuals not lawfully present Nothing in this subtitle or the amendments made by this subtitle allows Federal payments, credits, or cost-sharing reductions for individuals who are not lawfully present in the United States. (e) State flexibility Nothing in this subtitle or the amendments made by this subtitle shall be construed to prohibit a State from making payments to or on behalf of an individual for coverage under a qualified health plan offered through an Exchange that are in addition to any credits or cost-sharing reductions allowable to the individual under this subtitle and such amendments.
Official text at uscode.house.gov ↗