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ELECTRONIC CODE OF FEDERAL REGULATIONS
e-CFR data is current as of July 19, 2018
Title 26 → Chapter I → Subchapter A → Part 1 → §1.36b-2
Title 26: Internal Revenue
PART 1—INCOME TAXES
§1.36B-2 Eligibility for premium tax credit.
(a) In general. An applicable taxpayer (within the meaning of paragraph (b) of this section) is allowed a premium assistance
amount only for any month that one or more members of the applicable taxpayer’s family (the applicable taxpayer or the
applicable taxpayer’s spouse or dependent)—
(1) Is enrolled in one or more qualified health plans through an Exchange; and
(2) Is not eligible for minimum essential coverage (within the meaning of paragraph (c) of this section) other than coverage
described in section 5000A(f)(1)(C) (relating to coverage in the individual market).
(b) Applicable taxpayer—(1) In general. Except as otherwise provided in this paragraph (b), an applicable taxpayer is a
taxpayer whose household income is at least 100 percent but not more than 400 percent of the Federal poverty line for the
taxpayer’s family size for the taxable year.
(2) Married taxpayers must file joint return—(i) In general. Except as provided in paragraph (b)(2)(ii) of this section, a
taxpayer who is married (within the meaning of section 7703) at the close of the taxable year is an applicable taxpayer only if
the taxpayer and the taxpayer’s spouse file a joint return for the taxable year.
(ii) Victims of domestic abuse and abandonment. Except as provided in paragraph (b)(2)(v) of this section, a married
taxpayer satisfies the joint filing requirement of paragraph (b)(2)(i) of this section if the taxpayer files a tax return using a filing
status of married filing separately and the taxpayer—
(A) Is living apart from the taxpayer’s spouse at the time the taxpayer files the tax return;
(B) Is unable to file a joint return because the taxpayer is a victim of domestic abuse, as described in paragraph (b)(2)(iii) of
this section, or spousal abandonment, as described in paragraph (b)(2)(iv) of this section; and
(C) Certifies on the return, in accordance with the relevant instructions, that the taxpayer meets the criteria of this
paragraph (b)(2)(ii).
(iii) Domestic abuse. For purposes of paragraph (b)(2)(ii) of this section, domestic abuse includes physical, psychological,
sexual, or emotional abuse, including efforts to control, isolate, humiliate, and intimidate, or to undermine the victim’s ability to
reason independently. All the facts and circumstances are considered in determining whether an individual is abused, including
the effects of alcohol or drug abuse by the victim’s spouse. Depending on the facts and circumstances, abuse of the victim’s
child or another family member living in the household may constitute abuse of the victim.
(iv) Abandonment. For purposes of paragraph (b)(2)(ii) of this section, a taxpayer is a victim of spousal abandonment for a
taxable year if, taking into account all facts and circumstances, the taxpayer is unable to locate his or her spouse after
reasonable diligence.
(v) Three-year rule. Paragraph (b)(2)(ii) of this section does not apply if the taxpayer met the requirements of paragraph (b)
(2)(ii) of this section for each of the three preceding taxable years.
(3) Dependents. An individual is not an applicable taxpayer if another taxpayer may claim a deduction under section 151
for the individual for a taxable year beginning in the calendar year in which the individual’s taxable year begins.
(4) Individuals not lawfully present or incarcerated. An individual who is not lawfully present in the United States or is
incarcerated (other than incarceration pending disposition of charges) is not eligible to enroll in a qualified health plan through
an Exchange. However, the individual may be an applicable taxpayer if a family member is eligible to enroll in a qualified health
plan. See sections 1312(f)(1)(B) and 1312(f)(3) of the Affordable Care Act (42 U.S.C. 18032(f)(1)(B) and (f)(3)) and §1.36B-3(b)
(2).
(5) Individuals lawfully present. If a taxpayer’s household income is less than 100 percent of the Federal poverty line for the
taxpayer’s family size and the taxpayer or a member of the taxpayer’s family is an alien lawfully present in the United States,
the taxpayer is treated as an applicable taxpayer if—
(i) The lawfully present taxpayer or family member is not eligible for the Medicaid program; and
(ii) The taxpayer would be an applicable taxpayer if the taxpayer’s household income for the taxable year was between 100
and 400 percent of the Federal poverty line for the taxpayer’s family size.
(6) Special rule for taxpayers with household income below 100 percent of the Federal poverty line for the taxable year—(i)
In general. A taxpayer (other than a taxpayer described in paragraph (b)(5) of this section) whose household income for a
taxable year is less than 100 percent of the Federal poverty line for the taxpayer’s family size is treated as an applicable
taxpayer for the taxable year if—
(A) The taxpayer or a family member enrolls in a qualified health plan through an Exchange for one or more months during
the taxable year;
(B) An Exchange estimates at the time of enrollment that the taxpayer’s household income will be at least 100 percent but
not more than 400 percent of the Federal poverty line for the taxable year;
(C) Advance credit payments are authorized and paid for one or more months during the taxable year; and
(D) The taxpayer would be an applicable taxpayer if the taxpayer’s household income for the taxable year was at least 100
but not more than 400 percent of the Federal poverty line for the taxpayer’s family size.
(ii) Exceptions. This paragraph (b)(6) does not apply for an individual who, with intentional or reckless disregard for the
facts, provides incorrect information to an Exchange for the year of coverage. A reckless disregard of the facts occurs if the
taxpayer makes little or no effort to determine whether the information provided to the Exchange is accurate under
circumstances that demonstrate a substantial deviation from the standard of conduct a reasonable person would observe. A
disregard of the facts is intentional if the taxpayer knows the information provided to the Exchange is inaccurate.
(iii) Advance credit payments are authorized and paid for one or more months during the taxable year; and
(iv) The taxpayer would be an applicable taxpayer if the taxpayer’s household income for the taxable year was between
100 and 400 percent of the Federal poverty line for the taxpayer’s family size.
(7) Computation of premium assistance amounts for taxpayers with household income below 100 percent of the Federal
poverty line. If a taxpayer is treated as an applicable taxpayer under paragraph (b)(5) or (b)(6) of this section, the taxpayer’s
actual household income for the taxable year is used to compute the premium assistance amounts under §1.36B-3(d).
(c) Minimum essential coverage—(1) In general. Minimum essential coverage is defined in section 5000A(f) and
regulations issued under that section. As described in section 5000A(f), government-sponsored programs, eligible employersponsored
plans, grandfathered health plans, and certain other health benefits coverage are minimum essential coverage.
(2) Government-sponsored minimum essential coverage—(i) In general. An individual is eligible for government-sponsored
minimum essential coverage if the individual meets the criteria for coverage under a government-sponsored program described
in section 5000A(f)(1)(A) as of the first day of the first full month the individual may receive benefits under the program, subject
to the limitation in paragraph (c)(2)(ii) of this section. The Commissioner may define eligibility for specific governmentsponsored
programs further in additional published guidance, see §601.601(d)(2) of this chapter.
(ii) Obligation to complete administrative requirements to obtain coverage. An individual who meets the criteria for eligibility
for government-sponsored minimum essential coverage must complete the requirements necessary to receive benefits. An
individual who fails by the last day of the third full calendar month following the event that establishes eligibility under paragraph
(c)(2)(i) of this section to complete the requirements to obtain government-sponsored minimum essential coverage (other than a
veteran’s health care program) is treated as eligible for government-sponsored minimum essential coverage as of the first day
of the fourth calendar month following the event that establishes eligibility.
(iii) Special rule for coverage for veterans and other individuals under chapter 17 or 18 of title 38, U.S.C. An individual is
eligible for minimum essential coverage under a health care program under chapter 17 or 18 of title 38, U.S.C. only if the
individual is enrolled in a health care program under chapter 17 or 18 of title 38, U.S.C. identified as minimum essential
coverage in regulations issued under section 5000A.
(iv) Retroactive effect of eligibility determination. If an individual receiving advance credit payments is determined to be
eligible for government-sponsored minimum essential coverage that is effective retroactively (such as Medicaid), the individual
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