Obamacare for 2027: enrollment deadlines, how the subsidy works, green card vs. H-1B, and reconciling at tax time

Obamacare is the individual health insurance Marketplace created by the 2010 Affordable Care Act (ACA). You buy a private insurer's plan on HealthCare.gov or your state's exchange, and depending on income you can get a federal premium tax credit. Insurers can't turn you down or charge more because of a pre-existing condition.

• Who can buy: People who live in the U.S., are citizens, U.S. nationals or lawfully present, and aren't incarcerated. Undocumented immigrants can't buy Marketplace coverage, even at full price. Since August 2025, under CMS's rule, DACA recipients are no longer treated as lawfully present and can't enroll on the federal platform.
• Medicare enrollees: Generally can't buy a Marketplace plan or get the credit (see "Turning 65" below).
• People with job-based coverage: Can buy, but if the employer plan is affordable and meets minimum value, there is no credit (see below).
• People living abroad: The Marketplace only covers U.S. residents. If you live overseas or are retiring abroad, see the guide at yclcpa.com/retirechina.
• How premiums are set: Insurers may price only on age, location, family size and tobacco use, not on health or sex. The oldest adults pay at most three times what a 21-year-old pays.

Every plan covers 10 essential health benefits: outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services, lab tests, preventive care, and pediatric dental and vision. Many preventive services (checkups, vaccines, screenings) have no cost-sharing in network.

Description: Work down the steps; at any "No," read the result in the last column.

Step	Question	Yes	No
1	Living in the U.S., a citizen, national or lawfully present, not incarcerated?	You can buy; go to step 2	Can't buy on the Marketplace
2	Citizen, national, green card holder, Cuban/Haitian entrant or COFA migrant?	Go to step 3	Full price only, no subsidy
3	Eligible for Medicaid, CHIP, Medicare, or affordable employer coverage?	Generally no subsidy	Go to step 4
4	Household income between 100% and 400% of the poverty line, and filing jointly if married?	Subsidy; silver CSR below 250%	Above 400%: full price; below 100%: check Medicaid first

Open enrollment for 2027 coverage began November 1, 2026. On HealthCare.gov, including North Carolina, you must pick a plan by December 15 for coverage starting January 1, 2027. Open enrollment itself runs through January 15, 2027, and plans chosen December 16 to January 15 usually start February 1. State exchanges set their own dates.

CMS's June 2025 Marketplace Integrity and Affordability rule would have shortened federal open enrollment, starting with 2027 coverage, to November 1 through December 15, with state exchanges capped at nine weeks ending by December 31. A federal district court in Maryland vacated that provision on June 12, 2026, in *City of Columbus v. Kennedy*, and the government has appealed to the Fourth Circuit. CMS's October 30, 2026 fact sheet for plan year 2027 confirms that HealthCare.gov open enrollment runs from November 1, 2026 to January 15, 2027. So for most people December 15 is the deadline for January 1 coverage, not the last day to enroll. The appeal could affect windows in later years.

Check your own state exchange for other dates. Coverage starts only after you pay the first month's premium as the insurer requires.

Description: Dates run top to bottom; the last column is what you should do. The last row is tax filing for 2027 coverage.

Date	What happens	What to do
Nov 1, 2026	Open enrollment for 2027 opens	Update income, household and immigration details; compare plans instead of waiting for auto re-enrollment
Dec 15, 2026	Deadline for January 1 coverage	Pick a plan and pay the first premium as the insurer requires
Jan 1, 2027	Coverage starts; PTC limited to citizens and eligible aliens	H-1B, F-1 and similar households: check your bill, the subsidy is gone
Jan 15, 2027	HealthCare.gov open enrollment ends	Plans picked Dec 16 to Jan 15 usually start February 1
Jan 31, 2027	Exchanges issue Form 1095-A for 2026 coverage	Download it and check every month
Apr 15, 2027	File your 2026 return with Form 8962	First year with no repayment cap
During 2027	Income, household size, address, status or other coverage changes	Report it promptly (generally within 30 days) to adjust APTC
Jan 31 / Apr 15, 2028	Form 1095-A and Form 8962 for 2027 coverage	Premiums for family members who aren't eligible aliens get no credit

For tax years beginning on or after January 1, 2027, the premium tax credit is available only to U.S. citizens, U.S. nationals and three kinds of "eligible aliens": lawful permanent residents (green card holders), Cuban and Haitian entrants, and people living in the U.S. under a Compact of Free Association (COFA). Other lawfully present people, including H-1B, L-1, F-1, J-1 and H-4 holders, pending green card applicants, refugees and asylees without a green card, and TPS holders, can still buy Marketplace coverage at full price, but with no credit and no silver-plan cost-sharing reductions.

This comes from section 71301 of the One Big Beautiful Bill Act (signed July 4, 2025, P.L. 119-21), which amended Internal Revenue Code section 36B. HealthCare.gov's immigrant coverage page says the same: starting January 1, 2027, only these three noncitizen groups may qualify for lower premiums, and other statuses may buy coverage without savings.

Description: The first column is the status; the next three show whether the person can buy on the Marketplace and whether a premium tax credit is available in 2026 and in 2027; the last column has notes.

Status	Can buy?	2026 credit	2027 credit	Notes
U.S. citizen or national	Yes	Yes	Yes	If income qualifies
Green card holder (LPR)	Yes	Yes	Yes	Conditional residents are generally LPRs too; new LPRs usually wait 5 years for Medicaid
Cuban or Haitian entrant	Yes	Yes	Yes	As defined in the Refugee Education Assistance Act of 1980
COFA migrant (Marshall Islands, Micronesia, Palau)	Yes	Yes	Yes	Living in the U.S. under the Compacts
H-1B, L-1, O-1, E-2 and other work visas; H-4, L-2 and other dependents	Yes	Yes	No	Full price, or employer coverage
F-1 and J-1 students and scholars	Yes	Yes (nonresident aliens differ)	No	Most schools require school coverage
Pending green card (I-485), with a work permit	Yes	Yes	No	Report to the exchange once the green card arrives
Refugees and asylees without a green card	Yes	Yes	No	Eligible before; ends in 2027
TPS and most parolees	Yes	Yes	No	Cuban/Haitian entrants excepted
Any of the lawfully present groups above with income under 100% and barred from Medicaid by status	Yes	No (from 2026)	No	The old exception ended in 2026
DACA	Not on the federal platform	No	No	Excluded since August 2025
Undocumented	No	No	No	Can't buy on the Marketplace even at full price

• Full price is still an option: These statuses aren't barred from buying, only from the subsidy. KFF puts the 2027 national average benchmark silver premium at about $700 a month for a 40-year-old, so a family paying full price faces a large bill. Compare employer coverage first.
• Mixed-status families: The household doesn't lose everything. Under the tax rules, premiums for members who aren't eligible get no credit, but premiums for eligible members, such as a U.S.-born child or a spouse with a green card, may still be subsidized. The exchange calculates this person by person.
• Part of the change came in 2026: Starting in 2026, lawfully present immigrants with income below 100% of the poverty line who are barred from Medicaid because of status can no longer get the credit (section 71302). New green card holders still in the five-year Medicaid waiting period with very low income need to plan for this.
• Details still being written: The IRS issued proposed regulations on October 15, 2026 (REG-101576-26), with comments due November 30 and a hearing on December 8, 2026. How mid-year status changes are handled month by month will follow the final rules and the exchange's calculation.

The credit equals the premium of the second-lowest-cost silver plan (the benchmark, or SLCSP) for your household minus your "expected contribution." The expected contribution is household income times a percentage set by where your income falls relative to the poverty line, from 2.15% to 10.22% for 2027. You need income between 100% and 400% of the poverty line. The credit can be used on any metal level, but it can't exceed the premium of the plan you choose.

Step 1: Where does your income fall against the poverty line?

The credit uses the poverty guidelines published the prior year. 2027 coverage uses the 2026 HHS guidelines (published January 2026, 48 states and D.C.; Alaska and Hawaii are higher):

Add $5,680 per additional person. 2026 coverage, which you reconcile when filing in April 2027, uses the 2025 guidelines:

The 2025 guidelines add $5,500 per additional person. Medicaid and CHIP use the current year's guidelines and look at monthly income, so they measure differently.

Step 2: Find your expected contribution percentage

The IRS publishes the table each year (Rev. Proc. 2025-25 for 2026, Rev. Proc. 2026-26 for 2027), and the percentage rises proportionally within each band:

Step 3: Benchmark premium minus expected contribution

The benchmark is the second-cheapest silver plan available to the people in your household where you live, priced by ZIP code and each person's age; on Form 1095-A it's column B. Choose a cheaper bronze plan and the credit stays the same while you pay less; choose gold and you pay more.

• The 400% cliff is back: From 2021 through 2025, enhanced subsidies capped contributions at 8.5% of income and allowed credits above 400%. They expired December 31, 2025. The House passed a three-year extension (H.R. 1834) 230–196 on January 8, 2026, but the Senate never voted, and as of November 2026 no extension has become law. One extra dollar of income can now cost the entire year's credit.
• Advance or at tax time: The credit can be paid monthly to your insurer (APTC) or claimed in full when you file. Advance payments use your income estimate and must be reconciled against actual income.
• Premiums are rising: KFF reports that average benchmark silver premiums rise 13% for 2027 (11% in HealthCare.gov states). Because the credit tracks the benchmark, subsidized enrollees may see less of the increase; unsubsidized enrollees bear all of it. Some states, such as California, New Jersey and New Mexico, add their own subsidies; North Carolina doesn't.

Metal levels describe the share of average medical costs the plan pays: about 60% for bronze, 70% for silver, 80% for gold and 90% for platinum. Lower premiums mean more out of pocket when you get care. If you qualify for the credit with income below 250% of the poverty line, silver plans come with cost-sharing reductions (CSR) that can bring coverage close to gold or platinum. Which plan to choose is your decision; below are the factors to weigh.

What to look at when choosing

• Doctors and hospitals in network: HMOs and EPOs generally cover only in-network care; PPOs pay part of out-of-network care. Check the doctors and hospitals you use.
• Your prescriptions and the formulary tier they fall in.
• Deductible, coinsurance and the out-of-pocket maximum: If you expect a lot of care, compare premium plus likely out-of-pocket costs, not just premium.
• Expected events: pregnancy, chronic conditions, planned surgery.
• The credit and CSR: Below 250% of the poverty line, factor CSR into any silver comparison.

For plan terms, networks and claims questions, an exchange navigator or a licensed insurance agent can walk you through the details.

How much do cost-sharing reductions add?

CSR applies only to silver plans, and the lower your income, the larger the share the plan pays:

CSR is only for people eligible for the credit, so from 2027 it isn't available to H-1B and similar statuses. CSR isn't reconciled at tax time.

HSAs and direct primary care

• Bronze and catastrophic plans work with an HSA: Under the One Big Beautiful Bill Act, starting in 2026 Marketplace bronze and catastrophic plans are treated as high-deductible health plans (IRS Notice 2026-5), so you can open a health savings account. 2026 contribution limits are $4,400 self-only and $8,750 family, plus $1,000 at 55 or older.
• A double benefit: HSA contributions are deductible, which lowers MAGI and can raise your credit or bring you back under the 400% line.
• Telehealth: Plans can now permanently cover telehealth before the deductible without affecting HSA eligibility.
• Direct primary care (DPC): Starting in 2026, DPC membership fees up to $150 a month ($300 for family arrangements) don't affect HSA eligibility and can be paid from the HSA.

Who can buy a catastrophic plan?

For 2027, catastrophic plans are generally limited to people under 30 or those with a hardship exemption, including the affordability exemption. A 2027 payment notice provision that would have widened eligibility was stayed by a federal court on July 16, 2026. The premium tax credit can't be used for catastrophic plans.

You enter your estimated household income for the year: the modified adjusted gross income (MAGI) of everyone in your tax household. MAGI equals AGI from your return plus tax-exempt interest, foreign earned income and housing excluded on Form 2555, and the nontaxable part of Social Security benefits. Your tax household is you, your spouse if filing jointly, and the dependents you claim, not everyone living under your roof.

Who counts in your household?

• It follows the tax return, not the address: Parents or adult children living with you aren't in your household unless you claim them as dependents; otherwise they apply on their own.
• Dependents' income: Add a dependent's income only if that dependent is required to file a return (for example, wages above the standard deduction).
• Married filing separately generally disqualifies you: Married couples must file jointly. The exception is a victim of domestic abuse or spousal abandonment who can't file jointly, checked on Form 8962, and it can't be used more than three years in a row.
• Divorce, separation and children: A child counts in the household of whoever claims the child. A marriage or divorce during the year triggers special allocation rules on Form 8962.

How to estimate each type of income

Description: The first column is the income type, the middle column says whether and how it counts, and the last column has estimating tips.

Income type	Counts toward MAGI?	Tips
Wages (W-2)	Yes, after 401(k) deferrals and pre-tax premiums	Raises, bonuses and RSU vesting are all wages
Self-employment, 1099, rideshare and delivery	Yes, net profit (Schedule C income minus expenses)	Then subtract half of SE tax, the self-employed health insurance deduction, and SEP or solo 401(k) contributions
Rental income	Yes, Schedule E net after depreciation	Losses are limited by passive activity rules
Sales of stock, funds, crypto	Yes, net capital gains	A big December sale can push you over 400%
Interest and dividends	Yes; add back tax-exempt municipal bond interest	—
Traditional IRA and 401(k) withdrawals, pensions	Yes, the taxable part	Roth conversions count; ordinary rollovers don't
Social Security	Yes, including the nontaxable part	Use total annual benefits
Foreign income (wages, rent, interest, pensions)	Yes, converted to dollars	Tax residents report worldwide income; add back amounts excluded on Form 2555
Unemployment, gambling winnings, jury pay, alimony under pre-2019 divorce agreements	Yes	—
Gifts, inheritances, child support, loans, SSI, veterans' disability	No	Large foreign gifts have their own reporting (see yclcpa.com/gift)
Qualified Roth IRA distributions, HSA withdrawals for medical costs	No	—

• Self-employed or uneven income: Start from last year's return and adjust for this year's contracts and orders; use your best reasonable estimate. For self-employed people with Marketplace coverage, the self-employed health insurance deduction and the credit affect each other (the deduction lowers AGI and raises the credit, while the credit reduces the deductible premium). IRS Publication 974 explains the calculation, and tax software or your CPA handles it. For 1099 income, see yclcpa.com/1099nec.
• Estimate high or low? Underestimate and you get more in advance and repay it at tax time, with no cap from 2026; overestimate and you get less in advance and the rest back as a refund. Near the 400% line, err on the conservative side. You can also take only part of the credit in advance, or make estimated tax payments (see yclcpa.com/1040es).
• Legal ways to lower MAGI: Traditional 401(k), traditional IRA and HSA contributions, and SEP or solo 401(k) contributions if you're self-employed. You can also time stock sales, Roth conversions and retirement withdrawals. Weigh these against your retirement plan.
• Estimated above 100%, actual below 100%: If the exchange granted advance credits based on a reasonable estimate and your actual income ends up under 100% of the poverty line, you can generally keep your eligibility under the rules, unless you intentionally misstated income.

If you had Marketplace coverage, the exchange sends Form 1095-A by January 31, listing monthly premiums, benchmark premiums and advance credits. You use it to complete Form 8962, which recalculates the credit on actual income: excess advance credit is repaid on Schedule 2, and any additional credit is refundable on Schedule 3. If you received advance credits, you must file a return with Form 8962 even if your income is below the filing threshold.

• The three columns on Form 1095-A: Column A is your plan's premium, column B the benchmark silver premium, column C the advance credit. From 2027, under the proposed rules, exchanges will remove premiums for ineligible family members from these amounts.
• No more repayment cap: Through 2025, households below 400% had a cap on repaying excess advance credit. Starting with tax year 2026 it's gone, and you repay whatever was overpaid. Filing 2026 returns in spring 2027 is the first time the new rule applies.
• Shared policies: When a policy covers more than one tax household, or after a marriage or divorce, the amounts are allocated on Form 8962 following the IRS instructions.
• If you don't reconcile: The IRS will write asking for Form 8962 and may hold your refund. For 2026 and 2027, exchanges aren't cutting off advance credits for failure to reconcile (because of the court ruling and CMS guidance), but the statute requires it from 2028.

Example (hypothetical numbers, to show the method): A family of three in North Carolina, all citizens or green card holders, enrolls through HealthCare.gov for 2027 and estimates MAGI of $70,000. Assume the local benchmark silver plan costs $1,600 a month for the family, or $19,200 a year.

If income rises from $70,000 to $100,000, the family repays $4,025. If it reaches $112,000, above the 400% line of $109,280, they repay all $13,005. In the past, households below 400% had a repayment cap; starting with tax year 2026, they don't. If you know income is rising, update the exchange to reduce advance payments; HSA, traditional IRA or 401(k) contributions before year-end may also bring MAGI back under 400%.

What if Form 1095-A is wrong or missing?

• Check it first: Look at the people covered, premiums and advance credit for each month. Months when someone was added or dropped, the plan changed or you moved are where errors happen, and column B is the most common problem.
• Didn't receive it: Download it from your HealthCare.gov or state exchange account. Forms 1095-B and 1095-C from insurers or employers can't be used for Form 8962.
• It's wrong: Ask the exchange to correct it; the corrected form is marked "CORRECTED."
• Corrected after you filed: Recompute Form 8962 with the new numbers; if the result changes, you'll generally file Form 1040-X.
• More than one 1095-A: Changing plans, moving states, or separate policies for family members produce multiple forms, and all of them go on Form 8962.

Report changes in income, household size, address, immigration status or other coverage to the exchange promptly, generally within 30 days. The exchange recalculates your advance credit, and some changes open a special enrollment period to switch plans. If you don't report, the difference shows up at tax time, and from 2026 any excess is repaid in full.

Changes to report

• A significant rise or drop in income: a new job, starting self-employment, a large bonus, stock sales
• Marriage, divorce, birth, adoption, a death in the family, or changes in dependents
• A move, even to a new ZIP code in the same state, since premiums and the benchmark may differ
• Gaining job-based coverage, Medicaid, Medicare or other coverage
• An immigration status change, such as a green card or naturalization; incarceration or release
• Reporting an income change doesn't always let you switch plans, but it adjusts your advance credit.

Moving to another state

• A move to a new coverage area usually opens a 60-day special enrollment period, generally if you had coverage for at least one day in the 60 days before the move (moves from abroad are an exception).
• Your old plan usually doesn't follow you; you apply again in the new state, and each exchange issues its own Form 1095-A for your return.
• Moving to a state with its own exchange, such as California, New York or New Jersey, means applying on that state's site, not HealthCare.gov.
• State tax and individual mandate rules may differ (see below).

Leaving the U.S.

• The Marketplace covers only U.S. residents. If you move abroad, end your coverage through the exchange; only months while you lived here can carry a credit.
• If you remain a U.S. tax resident or citizen, you still file a U.S. return, and you attach Form 8962 for any year with advance credits.
• Moving back to the U.S. later is a qualifying event, usually with 60 days to enroll. For retiring abroad, see yclcpa.com/retirechina.

Turning 65 and moving to Medicare

• Once you're eligible for premium-free Medicare Part A at 65, you generally can't keep the Marketplace credit. Marketplace coverage doesn't end automatically; cancel it through the exchange, or you'll repay the excess credit.
• Medicare's initial enrollment period is seven months around your 65th birthday month. Missing it can mean a late enrollment penalty for Part B later, and Marketplace coverage doesn't substitute.
• People under 65 who get Medicare because of a disability also lose the credit. For choosing and enrolling in Medicare, see yclcpa.com/medicare.

Settled changes: the enhanced subsidies expired after 2025; from tax year 2026 excess advance credit is repaid in full, income-based special enrollment no longer carries a credit, and lawfully present immigrants below 100% lose the credit; from 2027 the credit is limited to green card holders and a few other groups. Most of the tighter rules in CMS's 2025 rule (shorter enrollment, the $5 auto re-enrollment charge, extra income checks, cutting off credits for failure to reconcile) have been vacated or stayed by courts. The statute's pre-enrollment verification starts in 2028.

Description: Rows are ordered by the year each change starts; the source column shows whether it comes from the statute or a CMS rule, and the last column shows its current status.

Year	Change	Source	Status
2025	DACA recipients no longer treated as lawfully present; can't buy on the federal platform	CMS 2025 rule	In effect (since August 2025)
2025	One Big Beautiful Bill Act signed	P.L. 119-21 (July 4, 2025)	Provisions start on the dates below
2025	Seven CMS rule provisions stayed	*City of Columbus v. Kennedy* (Aug 22, 2025)	Nine provisions vacated June 12, 2026
2026	Enhanced subsidies expire; no credit above 400%	The 2022 IRA extended them only through 2025	In effect; House-passed extension never got a Senate vote
2026	Repayment caps on excess APTC eliminated	OBBBA sec. 71305	In effect (tax years from 2026)
2026	No credit for lawfully present immigrants under 100% barred from Medicaid by status	OBBBA sec. 71302	In effect (tax years from 2026)
2026	No credit for coverage through an income-based special enrollment period; the monthly SEP under 150% paused	OBBBA sec. 71304; CMS 2025 rule	In effect (plan years from 2026)
2026	Bronze and catastrophic plans HSA-compatible; DPC allowed with an HSA	OBBBA; IRS Notice 2026-5	In effect (from 2026)
2026	$5 monthly charge after auto re-enrollment into a $0 plan	CMS 2025 rule (2026 only)	Vacated
2026	Stricter income checks, end of the 60-day extension for data matching, pre-enrollment SEP verification	CMS 2025 rule	Vacated
2026	Insurers may require past-due premiums before new coverage	CMS 2025 rule	Vacated
2027	Credit limited to citizens and eligible aliens	OBBBA sec. 71301	From January 1, 2027; IRS proposed rules out for comment
2027	Federal open enrollment shortened to December 15	CMS 2025 rule	Vacated, under appeal; 2027 enrollment still runs to January 15
2027	Cutting off APTC for failure to file and reconcile (FTR)	CMS rules	Suspended for 2026 and 2027 (CMS guidance, July 22, 2026)
2027	Income and SEP verification, broader catastrophic eligibility, end of standardized plans, and more	2027 payment notice	Stayed by court (July 16, 2026)
2027	Medicaid work requirements in expansion states; people denied for not meeting them can't switch to the credit	OBBBA	Must start by January 1, 2027
2028	No credit for months before the exchange verifies income, status, other coverage and more	OBBBA sec. 71303	Tax years from 2028
2028	Failure to reconcile bars advance credits by statute	OBBBA sec. 71303	From 2028

• The litigation continues: In *City of Columbus v. Kennedy* (D. Md.), the court stayed seven provisions on August 22, 2025 and vacated nine on June 12, 2026; the government has appealed. In a second *City of Columbus* case over the 2027 payment notice, the court stayed eight provisions on July 16, 2026. A separate case brought by California and other states is pending. Outcomes may change the rules from 2028 on.
• Congress may still act: As of November 2026, neither the House-passed extension of the enhanced credits nor the bipartisan Senate discussions have become law. Whether the new Congress takes it up in 2027 remains to be seen.

If your income is low, the exchange first checks whether you qualify for Medicaid or CHIP, and anyone eligible for Medicaid can't get the Marketplace credit. North Carolina expanded Medicaid on December 1, 2023, covering adults 19 to 64 with income up to about 138% of the poverty line; limits for children and pregnant women are higher. You can apply for Medicaid any time of year.

• North Carolina's expansion: Before, many low-income adults earned too little for the credit (under 100%) but didn't qualify for Medicaid. Expansion closed that gap.
• Work requirements: The 2025 law requires expansion states to apply work or community engagement requirements to certain adults by January 1, 2027 (extensions are possible). People denied or dropped for not meeting them can't switch to the Marketplace credit.
• Immigration status: New green card holders generally wait five years for full Medicaid (some states make exceptions for children and pregnant women). From October 1, 2026, federal Medicaid for noncitizens is limited to green card holders, Cuban and Haitian entrants and COFA migrants; refugees and asylees generally lose federal Medicaid until they get a green card. Emergency Medicaid is unaffected.
• CHIP: Children in families above the Medicaid limit but with modest income can get children's coverage (North Carolina folded NC Health Choice into Medicaid).

If your employer offers coverage that is affordable and meets minimum value, you and the family members who can enroll in it can't get the credit. Affordable means the employee's share of the cheapest self-only plan is no more than 9.96% of household income for 2026, or 10.22% for 2027. Since 2023, family members are tested on the cost of family coverage, so they may qualify for the credit when family coverage is expensive.

Employees

• Turning down affordable employer coverage to buy a Marketplace plan doesn't make you eligible for the credit.
• The family glitch fix: Before 2023, affordability looked only at the employee's self-only cost, so family members were shut out even when family coverage was very expensive. Since 2023, family members are tested on whether the employee's cost for family coverage exceeds the same percentage of income.
• The application asks about employer coverage; HealthCare.gov's Employer Coverage Tool is a form you can ask HR to fill in.
• Being eligible for employer coverage counts even if you don't enroll. After leaving a job you can elect COBRA, but dropping COBRA midway to switch to the Marketplace has timing traps.

ICHRA and QSEHRA

• ICHRA: The employer funds an account you use to buy individual coverage. If the ICHRA is affordable, you can't get the credit; if it isn't, you can opt out and claim the credit instead.
• QSEHRA: A small employer's reimbursement allowance. If it's affordable, there is no credit; if it isn't, the credit is reduced by the QSEHRA amount. Report it accurately on the application and the return.

Small business owners

• Small business health care tax credit: Employers with fewer than 25 full-time equivalent employees and modest average wages that buy group coverage through SHOP can claim a credit on Form 8941 of up to 50% of employer premiums (35% for tax-exempt employers), for up to two consecutive years.
• S corporation owners: For shareholders owning more than 2%, health insurance paid by the company (including a Marketplace plan reimbursed by the company) goes into W-2 wages and is then deducted as self-employed health insurance on the personal return; if you also receive the credit, the deductible amount is reduced by it (see yclcpa.com/scorp).
• Sole proprietors and 1099 freelancers: Without employer coverage, the Marketplace is the main option. Premiums qualify for the self-employed health insurance deduction, calculated together with the credit under Publication 974.
• Founders sponsoring their own H-1B: No credit from 2027; consider group coverage or an ICHRA through the company (see yclcpa.com/h1b).

H-1B, L-1, H-4, F-1 and J-1 households lose the credit in 2027. They can still buy Marketplace coverage at full price, but should compare employer and school plans first. If you get a green card mid-year, you may qualify from that point on, so report it to the exchange right away. In mixed-status families, the share for citizen and green card members may still be subsidized.

Example (hypothetical numbers, to show the method): A family of three in North Carolina: the husband on H-1B, wife and child on H-4, MAGI of $90,000 for 2027, and an assumed benchmark silver premium of $19,200 a year.

(For comparison, the benchmark premium is assumed to be the same in both years.) With the same income, the family pays over $10,000 more in 2027. If the child were a U.S.-born citizen, the child's share of the premium might still be subsidized; the exchange's calculation controls.

• H-1B and L-1 households: Start with employer coverage. It usually costs less than a full-price Marketplace plan because the employer shares the premium and your share is pre-tax. If you miss the employer's open enrollment, you wait for a qualifying event such as marriage or a birth.
• Still receiving advance credit in 2027? Your status may not have been updated. Excess credit is repaid in full at tax time, so correct your status with the exchange promptly.
• F-1 and J-1 students and scholars: Most schools require their own plan or coverage that meets their standards. Students are generally nonresident aliens for their first five calendar years (scholars, two), file Form 1040-NR (see yclcpa.com/1040nr), and from 2027 can't get the credit in any case.
• Green card holders: Eligible for the credit. New green card holders usually wait five years for Medicaid, and from 2026 those under 100% of the poverty line can't rely on the credit either, so plan carefully.
• Green card arrives mid-year: If you already bought a full-price Marketplace plan, report the green card promptly (generally within 30 days) so the credit can be recalculated. If you aren't enrolled, whether you get a special enrollment period depends on the exchange's rules. How the months are counted will follow the final IRS regulations.
• Nonresident spouse or no SSN: You must file jointly to get the credit; a nonresident spouse would need to elect to be treated as a resident, and a spouse without an SSN needs an ITIN (see yclcpa.com/itin). Family members who aren't applying for coverage don't need to provide an SSN on the application.
• New arrivals: Moving to the U.S. from abroad is a qualifying event, usually with 60 days to enroll; your first-year tax residency depends on your days in the U.S.

Apply online at HealthCare.gov (used in North Carolina) or your state's exchange, by phone, or with a navigator. Have each person's SSN or immigration document numbers, an income estimate for the year, and your employer's coverage details ready. Outside open enrollment, events such as marriage, a birth, losing coverage, a move or gaining lawful status usually give you 60 days to enroll.

Document checklist

• Each household member's date of birth; SSNs for those who have them (not required for members not applying)
• Immigration documents: green card, I-94, EAD, I-20, DS-2019, visa, and the document numbers
• Income: recent pay stubs, W-2s, 1099s, last year's return, a profit and loss statement if self-employed, and your estimate for the year
• Employer coverage: employer name, address, phone, and the employee's premium share (HR can complete the Employer Coverage Tool)
• Current coverage: policy numbers and end dates

Enrollment steps

1. Create an account on HealthCare.gov or your state exchange and complete the application (household, status, income, other coverage).
2. Review the eligibility results: whether you can buy, whether you get a credit and CSR, and whether you need to send proof of status or income.
3. Compare plans, choose one, and decide whether to take the credit in advance, in part, or at tax time.
4. Pay the first month's premium as the insurer requires; coverage starts only after that.
5. If the exchange asks for documents (a data matching issue), upload them by the deadline, or your credit or coverage may end.

Special enrollment periods

• Losing job-based, student, Medicaid or other coverage, or exhausting COBRA (generally 60 days before or after)
• Marriage, birth, adoption, or a court-ordered dependent
• Moving to a new coverage area (usually with prior coverage), or moving to the U.S. from abroad
• Gaining citizenship or lawful presence; release from incarceration
• Income-only special enrollment: since 2026, even if you can enroll, there is no credit
• Some special enrollment periods require proof, such as a coverage termination letter or marriage certificate

Not at the federal level. The federal individual mandate penalty has been $0 since 2019, and North Carolina has no penalty. California, Massachusetts, New Jersey, Rhode Island and the District of Columbia have their own mandates, with a penalty or exemption claimed on the state return for months without coverage.

• North Carolina: No penalty, though you carry the cost of any care without coverage.
• Mandate states: California, Massachusetts, New Jersey, Rhode Island and D.C. ask about coverage on the state return; penalty amounts and exemptions follow each state's rules. If you move in or out during the year, it applies to the months you lived there.
• Short-term plans and health sharing ministries: These aren't ACA plans, may exclude pre-existing conditions, and don't satisfy these state mandates.

Start with each family member's status, a rough estimate of the year's income, and whether anyone has job-based coverage, then find your situation below.

• Situation A: A citizen or green card household in North Carolina with self-employment or 1099 income. Estimate MAGI carefully, especially near the 400% line, and update it if income changes. At tax time, prepare Form 8962 from Form 1095-A together with the self-employed health insurance deduction and estimated taxes.
• Situation B: An H-1B, L-1 or H-4 household. No credit from 2027; compare employer coverage first. A U.S.-citizen child's share may still be subsidized. If advance credit is still being paid in 2027, correct it now or repay it in full at tax time.
• Situation C: F-1 or J-1 students and scholars. Check the school's insurance requirement first; Marketplace coverage is full price. You're most likely a nonresident alien filing Form 1040-NR.
• Situation D: A new green card holder with modest income. You can get the credit, but Medicaid usually requires a five-year wait, and from 2026 income under 100% means no credit either, so estimate income carefully.
• Situation E: Waiting on a green card that may arrive mid-year. Plan on full-price or employer coverage; when the green card arrives, report it so the credit can be recalculated, and reconcile month by month at tax time.
• Situation F: You received advance credit last year and income jumped this year. Estimate the 2026 repayment now, set the cash aside, and consider more withholding or estimated tax; raise your 2027 income estimate too.
• Situation G: Turning 65, or moving abroad for good. When you move to Medicare or leave the U.S., end your Marketplace coverage through the exchange to stop advance credits, and still file Form 8962 for that year.