Rule2024-29651
Definition of the Term “Coverage Month” for Computing the Premium Tax Credit
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
December 18, 2024
Effective
December 18, 2024
Issuing agencies
Treasury DepartmentInternal Revenue Service
Abstract
This document contains final regulations that amend the definition of "coverage month" and amend certain other rules in existing income tax regulations regarding the computation of an individual taxpayer's premium tax credit. The coverage month amendment generally provides that, in computing a premium tax credit, a month may be a coverage month for an individual if the amount of the premium paid, including by advance payments of the premium tax credit, for the month for the individual's coverage is sufficient to avoid termination of the individual's coverage for that month. The final regulations also amend the existing regulations relating to the amount of enrollment premiums used in computing the taxpayer's monthly premium tax credit if a portion of the monthly enrollment premium for a coverage month is unpaid. Finally, the final regulations clarify when an individual is considered to be not eligible for coverage under a State's Basic Health Program. The final regulations affect taxpayers who enroll themselves, or enroll a family member, in individual health insurance coverage through a Health Insurance Exchange and may be allowed a premium tax credit for the coverage.
Full Text
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<title>Federal Register, Volume 89 Issue 243 (Wednesday, December 18, 2024)</title>
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[Federal Register Volume 89, Number 243 (Wednesday, December 18, 2024)]
[Rules and Regulations]
[Pages 102721-102726]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-29651]
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DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 1
[TD 10019]
RIN 1545-BR31
Definition of the Term ``Coverage Month'' for Computing the
Premium Tax Credit
AGENCY: Internal Revenue Service (IRS), Treasury.
ACTION: Final regulations.
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SUMMARY: This document contains final regulations that amend the
definition of ``coverage month'' and amend certain other rules in
existing income tax regulations regarding the computation of an
individual taxpayer's premium tax credit. The coverage month amendment
generally provides that, in computing a premium tax credit, a month may
be a coverage month for an individual if the amount of the premium
paid, including by advance payments of the premium tax credit, for the
month for the individual's coverage is sufficient to avoid termination
of the individual's coverage for that month. The final regulations also
amend the existing regulations relating to the amount of enrollment
premiums used in computing the taxpayer's monthly premium tax credit if
a portion of the monthly enrollment premium for a coverage month is
unpaid. Finally, the final regulations clarify when an individual is
considered to be not eligible for coverage under a State's Basic Health
Program. The final regulations affect taxpayers who enroll themselves,
or enroll a family member, in individual health insurance coverage
through a Health Insurance Exchange and may be allowed a premium tax
credit for the coverage.
DATES:
Effective date: These final regulations are effective on December
18, 2024.
Applicability date: These final regulations apply to taxable years
beginning on or after January 1, 2025.
FOR FURTHER INFORMATION CONTACT: Clara Raymond at (202) 317-4718 (not a
toll-free number).
SUPPLEMENTARY INFORMATION:
Authority
This document contains amendments to the Income Tax Regulations (26
CFR part 1) under section 36B of the Internal Revenue Code (Code).\1\
Section 36B(h) provides an express delegation of authority for the
Secretary of the Treasury or her delegate (Secretary) to prescribe such
regulations as may be necessary to carry out section 36B, including
regulations that provide for the coordination of the premium tax credit
(PTC) allowed under 36B with the program for advance payments of the
PTC (APTC) under section 1412 of the Affordable Care Act.\2\ The final
regulations are also issued under the express delegation of authority
under section 7805(a), which authorizes the Secretary to ``prescribe
all needful rules and regulations for the enforcement of [the Code],
including all rules and regulations as may be necessary by reason of
any alteration of law in relation to internal revenue.''
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\1\ Unless otherwise indicated, references to ``section'' or
``Sec. '' are to sections of the Code or the Treasury regulations
issued thereunder.
\2\ The Affordable Care Act (or ACA) refers to the Patient
Protection and Affordable Care Act (Pub. L. 111-148, enacted on
March 23, 2010), as amended by the Health Care and Education
Reconciliation Act of 2010 (Pub. L. 111-152, enacted on March 30,
2010).
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Background
I. Section 36B Rules Relating to Coverage Months and Monthly PTC Amount
Section 36B provides a PTC for applicable taxpayers who meet
certain eligibility requirements, including that a member of the
taxpayer's family enrolls in a qualified health plan (QHP) through a
Health Insurance Exchange (Exchange) for one or more ``coverage
months.''
Section 1.36B-3(c)(1) provides that a month is a coverage month for
an individual if (i) as of the first day of the month, the individual
is enrolled in a QHP through an Exchange; (ii) the taxpayer pays the
taxpayer's share of the premium for the individual's coverage under the
plan for the month by the unextended due date for filing the taxpayer's
income tax return for that taxable year, or the full premium for the
month is paid by APTC; and (iii) the individual is not eligible for the
full calendar month for minimum essential coverage (within the meaning
of Sec. 1.36B-2(c)) other than coverage described in section
5000A(f)(1)(C) of the Code (relating to coverage in the individual
market).
Section 1.36B-3(d)(1) provides that the PTC (also called the
premium assistance amount) for a coverage month is the lesser of (i)
the premiums for the month, reduced by any amounts that were refunded,
for one or more QHPs in which a taxpayer or a member of the taxpayer's
family enrolls (enrollment premiums); or (ii) the excess of the
adjusted monthly premium for the applicable benchmark plan over \1/12\
of the product of a taxpayer's household income and the applicable
percentage for the taxable year. The term ``family'' is defined in
Sec. 1.36B-1(d), and the applicable percentage is defined in Sec.
1.36B-3(g).
Section 1.36B-2(c)(2)(i) provides that, for purposes of determining
whether a given month is a coverage month for an individual, an
individual generally is considered 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.
Section 1.36B-2(c)(2)(v) provides that an individual is treated as
not eligible for Medicaid, CHIP, or a similar program for a period of
coverage under a QHP if, when the individual enrolls in the QHP, an
Exchange determines or considers (within the meaning of 45 CFR
155.302(b)) the individual to be not eligible for Medicaid or CHIP.
[[Page 102722]]
Section 36B(f)(3) and Sec. 1.36B-5 require Exchanges to report to
QHP enrollees and the IRS certain information, including monthly
enrollment premiums, needed to compute the PTC allowed for the
enrollee. This information is reported to enrollees on IRS Form 1095-A,
Health Insurance Marketplace Statement. The Centers for Medicare &
Medicaid Services (CMS), part of the Department of Health and Human
Services (HHS), is responsible for the Form 1095-A reporting for
Exchanges that use the Federal eligibility and enrollment platform
(Federally-facilitated Exchanges, or FFEs, and State-based Exchanges on
the Federal platform, or SBE-FPs). State Exchanges with their own
platforms (State Exchanges) are responsible for the Form 1095-A
reporting for individuals who enroll in a QHP through their State
Exchange.
II. HHS Rules Relating to Coverage When Premiums Are Unpaid
HHS regulations at 45 CFR 156.270(d) implement section
1412(c)(2)(B)(iv)(II) of the Affordable Care Act to require issuers of
QHPs to allow a ``grace period'' for enrollees for whom the APTC is
paid but who fail to timely pay their share of the premium for the
coverage. In general, a QHP issuer must provide a grace period of 3
consecutive months for such an enrollee before the issuer may terminate
the enrollee's coverage. During the first month of the grace period,
the QHP issuer must pay all appropriate claims for services rendered,
and, during the second and third months of the grace period, the QHP
issuer may pend claims.
HHS regulations at 45 CFR 155.400(g) allow issuers to implement a
premium payment threshold policy under which issuers can consider
enrollees to have paid all amounts due if the enrollees pay an amount
sufficient to maintain a percentage of total premium paid out of the
total premium owed equal to or greater than a level prescribed by the
issuer, provided that the level and the policy are applied in a uniform
manner to all enrollees. If an enrollee satisfies these conditions, the
issuer may provide coverage even though the full enrollment premium is
not paid.
In certain States, issuers also may provide coverage without
payment of the full enrollment premium if a State department of
insurance prohibits an issuer from terminating QHP coverage during a
declared emergency.
III. Proposed Regulations
On September 17, 2024, the Department of the Treasury (Treasury
Department) and the IRS published a notice of proposed rulemaking (REG-
116787-23) in the Federal Register (89 FR 75984) under section 36B
(proposed regulations). The proposed regulations would have changed the
definition of ``coverage month'' in Sec. 1.36B-3(c)(1) for some
scenarios for which the full premium for the month is unpaid by the
unextended due date of the taxpayer's return for the year of coverage,
provided the amount of the premium paid for the month, including by
APTC, is sufficient to avoid termination of the individual's coverage
for that month. The proposed regulations would have provided that a
month for which the enrollment premium is not fully paid may be a
coverage month in the following scenarios: (i) the first month of a
grace period described in 45 CFR 156.270(d); (ii) a month for which a
premium payment threshold under 45 CFR 155.400(g) has been met and for
which month the issuer of the individual's qualified health plan
provides coverage; and (iii) a month for which a State department of
insurance has, during a declared emergency, issued an order prohibiting
the issuer of the individual's qualified health plan from terminating
the individual's coverage for the month irrespective of whether the
full premium for the month is paid.
The proposed amendment to the definition of ``coverage month''
would have required a conforming change to the calculation of the
monthly PTC amount under Sec. 1.36B-3(d)(1)(i) so that the premium for
a month to be considered in determining the monthly PTC for an
individual's coverage would be reduced by any portion of the premium
that is unpaid as of the unextended due date for filing the taxpayer's
income tax return for the taxable year that includes the month.
Finally, the proposed regulations would have clarified Sec. 1.36B-
2(c)(2)(v) to provide that an individual is treated as not eligible for
Medicaid, CHIP, or a similar program such as a State's Basic Health
Program (BHP), for a period of coverage under a QHP if, when the
individual enrolls in the QHP, an Exchange conducts an eligibility
determination or, if applicable, eligibility assessment (within the
meaning of 45 CFR 155.302(b)) for Medicaid, CHIP, or a similar program
and determines or assesses the individual to be not eligible for
coverage under the program.
The Treasury Department and the IRS received nine public comments
in response to the notice of proposed rulemaking. Copies of the
comments are available for public inspection at <a href="https://www.regulations.gov">https://www.regulations.gov</a> or upon request. A public hearing on the proposed
regulations was scheduled for December 13, 2024. There were no requests
to speak at the scheduled public hearing. Consequently, the public
hearing was cancelled. After considering all the comments received, the
Treasury Department and the IRS adopt the proposed regulations without
modifications.
Summary of Comments and Explanation of Revisions
I. Overview
All nine public comments on the proposed regulations were in
support of the rules in the proposed regulations. One commenter
requested that the final regulations include detailed requirements,
expectations, and examples relating to reporting by Exchanges of
enrollment premiums and second lowest cost silver plan (SLCSP) premiums
on Form 1095-A for a month for which a taxpayer's share of the
enrollment premium is not paid in full (non-payment month) that may be
a coverage month. Another commenter requested that all non-payment
months for which coverage is provided be considered coverage months.
Finally, several commenters requested flexibility for Exchanges to
comply with the new coverage month rule. The comments are addressed in
more detail in Parts II through IV of this Summary of Comments and
Explanation of Revisions.
II. Additional Guidance for Reporting on Form 1095-A
As discussed in Part I of the Background section of this preamble,
section 36B(f)(3) and Sec. 1.36B-5 require Exchanges to report to QHP
enrollees and the IRS certain information needed to compute the PTC
allowed for the enrollee. This information is reported to enrollees on
IRS Form 1095-A. The enrollee's monthly enrollment premiums are
reported in column A of Part III of Form 1095-A and the enrollee's
monthly second lowest cost silver plan (SLCSP) premiums are reported in
column B of the form.
The current instructions for Form 1095-A require Exchanges to
report $0 in column A of Form 1095-A as the enrollment premium for a
non-payment month. The instructions also require Exchanges to report $0
for a non-payment month in column B of Form 1095-A as the amount of the
taxpayer's SLCSP premium for the month. Reporting $0 as the monthly
amount in either column A or column B signals to the taxpayer and the
IRS that this is not a coverage month and, thus, no PTC is allowed for
the month.
[[Page 102723]]
One commenter requested that the final regulations include detailed
requirements, expectations, and examples relating to how Exchanges
should report enrollment premiums and SLCSP premiums on Form 1095-A for
non-payment months that may be coverage months. The commenter asked
that the examples demonstrate how Exchanges should report multiple
grace periods in a calendar year, mid-month changes, and partial
payments.
The commenter's request for detailed guidance on how Exchanges
should report amounts on Form 1095-A is best addressed in the
Instructions for Form 1095-A, rather than in regulatory text. The IRS
intends to revise the 2025 Instructions for Form 1095-A to reflect the
coverage month changes in these final regulations. Specifically, the
revised instructions will require Exchanges to report in column A of
Part III of Form 1095-A the full enrollment premium for any month that
is a coverage month if such month is (i) the first month of a grace
period described in 45 CFR 156.270(d) for the plan enrollees; (ii) a
month for which a premium payment threshold under 45 CFR 155.400(g) has
been met and for which month the issuer of the individual's qualified
health plan provides coverage; or (iii) a month for which a State
department of insurance has, during a declared emergency, issued an
order prohibiting the issuer of the individual's qualified health plan
from terminating the individual's coverage for the month (the three
scenarios described in Sec. 1.36B-3(c)(4)). The instructions will
continue to provide that Exchanges must report $0 in column A for any
other months for which the full enrollment premium for the month is not
paid, and that the amount reported in column A should be reduced by any
enrollment premium refunds or credits.
Similarly, the instructions for column B of Part III of Form 1095-A
will be amended to provide that Exchanges should not report $0 as the
SLCSP premium for any months for which the full enrollment premium is
not paid, if the month is a coverage month under one of the three
scenarios described in Sec. 1.36B-3(c)(4). Instead, Exchanges should
report the SLCSP premium that would apply if the enrollment premium had
been paid in full.
With regard to the commenter's request for examples demonstrating
how to report amounts on Form 1095-A under the final regulations, the
Treasury Department and the IRS understand that State Exchanges may
need additional guidance as they proceed with implementation of these
final regulations. The Treasury Department and the IRS welcome
additional input and will continue to work with State Exchanges to
ensure that the Instructions for Form 1095-A adequately address how
Exchanges should report non-payment months as coverage months under one
of the three scenarios described in Sec. 1.36B-3(c)(4).
III. Additional Scenarios for Which Non-Payment Months May Be Coverage
Months
The proposed regulations included a request for comments on whether
the final regulations should include scenarios in addition to those
provided in the proposed regulations regarding non-payment months that
may be coverage months. One commenter suggested that the final
regulations should permit all non-payment months to be coverage months
as long as the amount of the premium paid for the month, including by
APTC, is sufficient to avoid termination of the individual's coverage
for that month.
In drafting the proposed regulations, the Treasury Department and
the IRS considered but rejected a rule that would allow all non-payment
months to be coverage months if the amount of the premium paid for the
month, including by APTC, is sufficient to avoid termination of the
individual's coverage for the month. As stated in the preamble to the
proposed regulations, a main reason for amending the coverage month
definition is to promote reporting consistency among Exchanges
regarding the reporting of enrollment premiums for non-payment months.
The Treasury Department and the IRS worked closely with HHS staff to
identify the three scenarios described in Sec. 1.36B-3(c)(4) as
scenarios for which there is inconsistent reporting among Exchanges. In
addition, the Treasury Department and the IRS have determined that an
open-ended rule that could be interpreted differently by different
Exchanges, based on their particular State law or practices, would not
achieve more consistent reporting among Exchanges. Exchanges, as well
as taxpayers and the IRS, need clarity on the definition of a coverage
month, and that definition needs to apply uniformly to all taxpayers
under the Federal tax law. Consequently, the Treasury Department and
the IRS do not adopt this comment, and the change to the coverage month
rule in the final regulations applies only for the three scenarios
described in Sec. 1.36B-3(c)(4).
IV. Applicability Date of Final Regulations
The proposed regulations provided that the changes under Sec. Sec.
1.36B-2 and 1.36B-3 were proposed to apply for taxable years beginning
on or after the first date of the calendar year that begins after the
date these regulations are published as final regulations in the
Federal Register. Several commenters noted that State Exchanges will
need to make extensive changes to their platform architecture to report
for non-payment months that are coverage months under one of the three
scenarios described in Sec. 1.36B-3(c)(4) and, thus, requested that
the final regulations provide adequate time for states to make the
necessary changes to ensure accurate reporting. One commenter stated
that a 9-12-month period is generally needed to implement IT changes.
Another commenter requested that the final rule include detailed
scenarios addressing the applicability date. One commenter supported
the proposed applicability date of the next calendar year following the
date of publication.
Consistent with the proposed applicability date, the rules in these
final regulations apply to taxable years beginning on or after January
1, 2025. Thus, a taxpayer may be allowed a PTC for 2025 for a non-
payment month that is a coverage month as described in these final
regulations. However, the Treasury Department and the IRS understand
that Exchanges need time to implement their reporting for the coverage
month rule in the final regulations, and some Forms 1095-A filed by
State Exchanges for the 2025 coverage year may not reflect that non-
payment months described in Sec. 1.36B-3(c)(4) are coverage months for
which a PTC is allowed. Exchanges should do the best they can to timely
implement the coverage month rule in these final regulations. Exchanges
are reminded that, because section 36B(f)(3) imposes the requirement on
Exchanges to report QHP enrollment information to the IRS and to
Enrollees on Form 1095-A, Form 1095-A is not an information return
within the meaning of section 6721, and there is no penalty imposed on
an Exchange for filing a Form 1095-A that does not include all of the
information required to be shown on the return or that includes
incorrect information. The Treasury Department and the IRS will
continue to consult with State Exchanges to assist with their
implementation of the coverage month rule under these final
regulations.
Finally, the proposed regulations included various applicability
dates to incorporate existing applicability dates for prior amendments
to the regulations under section 36B, but all of the amendments under
Sec. Sec. 1.36B-2 and 1.36B-3 in the proposed regulations
[[Page 102724]]
were proposed to apply on the same date. Those amendments to proposed
Sec. Sec. 1.36B-2 and 1.36B-3, as finalized in these regulations, all
apply to taxable years beginning on or after January 1, 2025. Thus, the
Treasury Department and the IRS do not believe detailed scenarios are
needed to address the final regulation's applicability date as
requested by one of the commenters.
V. Conforming Change to the PTC Calculation and Clarification of
Eligibility
As noted in Part III of the Background section of this preamble,
the proposed regulations addressed two items in addition to the change
to the coverage month definition. First, the proposed regulations
included a proposed change that would have conformed the calculation of
the monthly PTC amount under Sec. 1.36B-3(d)(1)(i) with the proposed
rule allowing certain non-payment months to be coverage months. Under
the proposed rule, taxpayers would have reduced the amount of the
enrollment premiums used to compute their monthly PTC by any portion of
the premium that is unpaid as of the unextended due date of the
taxpayer's income tax return for the taxable year that includes the
month. Second, the proposed regulations would have clarified Sec.
1.36B-2(c)(2)(v) to provide that an individual is treated as not
eligible for Medicaid, CHIP, or a similar program such as a State BHP,
for a period of coverage under a QHP if, when the individual enrolls in
the QHP, an Exchange conducts an eligibility determination or, if
applicable, eligibility assessment (within the meaning of 45 CFR
155.302(b)) for Medicaid, CHIP, or a similar program and determines or
assesses the individual to be not eligible for coverage under the
program. Because no negative comments or suggested changes were
received with respect to these two items, this Treasury decision adopts
these amendments without change.
VI. Severability
If any provision in this rulemaking is held to be invalid or
unenforceable facially, or as applied to any person or circumstance, it
shall be severable from the remainder of this rulemaking, and shall not
affect the remainder thereof, or the application of the provision to
other persons not similarly situated or to other dissimilar
circumstances.
Special Analyses
I. Regulatory Planning and Review
Pursuant to the Memorandum of Agreement, Review of Treasury
Regulations under Executive Order 12866 (June 9, 2023), tax regulatory
actions issued by the IRS are not subject to the requirements of
section 6 of Executive Order 12866, as amended. Therefore, a regulatory
impact assessment is not required.
II. Paperwork Reduction Act
These final regulations do not impose any additional information
collection requirements in the form of reporting, recordkeeping
requirements, or third-party disclosure statements. Taxpayers who claim
PTC on their income tax returns are required to file Form 8962, Premium
Tax Credit (PTC), which is the sole collection of information
requirement imposed on individuals by section 36B and the regulations
under section 36B. The rules in these final regulations will require
the IRS to revise the instructions for Form 8962. For purposes of the
Paperwork Reduction Act of 1995 (44 U.S.C. 3507(c)), the reporting
burden associated with the collection of information for Form 8962 will
be reflected in the PRA submission associated with income tax returns
under the OMB control number 1545-0074. To the extent there is a change
in burden because of these final regulations, the change in burden will
be reflected in the updated burden estimates for Form 8962.
In addition, Exchanges are required to report to QHP enrollees on
Form 1095-A certain information the enrollees need to compute the PTC
allowed for the enrollee and to reconcile the PTC with any APTC paid
for their coverage. Exchanges must also report this information to the
IRS. The rules in these final regulations will require the IRS to
revise the instructions for recipients of Form 1095-A and the
instructions for Exchanges completing Form 1095-A. For purposes of the
Paperwork Reduction Act of 1995 (44 U.S.C. 3507(c)), the reporting
burden associated with the collection of information for Form 1095-A
will be reflected in the PRA submission associated with Form 1095-A
under the OMB control number 1545-2232. To the extent there is a change
in burden because of these final regulations, the change in burden will
be reflected in the updated burden estimates for Form 1095-A.
III. Regulatory Flexibility Act
The Treasury Department and the IRS hereby certify that these final
regulations will not have a significant economic impact on a
substantial number of small entities pursuant to the Regulatory
Flexibility Act (5 U.S.C. chapter 6). This certification is based on
the fact that the majority of the effect of the final regulations falls
on individual taxpayers, and entities will experience only small
changes.
Pursuant to section 7805(f), the notice of proposed rulemaking
preceding these regulations was submitted to the Chief Counsel for the
Office of Advocacy of the Small Business Administration for comment on
their impact on small business, and no comments were received.
IV. Unfunded Mandates Reform Act
Section 202 of the Unfunded Mandates Reform Act of 1995 requires
that agencies assess anticipated costs and benefits and take certain
other actions before issuing a final rule that includes any Federal
mandate that may result in expenditures in any one year by a State,
local, or Tribal government, in the aggregate, or by the private
sector, of $100 million (updated annually for inflation). This final
rule does not include any Federal mandate that may result in
expenditures by State, local, or Tribal governments, or by the private
sector in excess of that threshold.
V. Executive Order 13132: Federalism
E.O. 13132 (Federalism) prohibits an agency from publishing any
rule that has federalism implications if the rule either imposes
substantial, direct compliance costs on State and local governments,
and is not required by statute, or preempts State law, unless the
agency meets the consultation and funding requirements of section 6 of
the E.O. This rule does not have federalism implications and does not
impose substantial direct compliance costs on State and local
governments or preempt State law within the meaning of the E.O.
VI. Congressional Review Act
Pursuant to the Congressional Review Act (5 U.S.C. 801 et seq.),
the Office of Information and Regulatory Affairs designated this rule
as not a major rule, as defined by 5 U.S.C. 804(2).
Statement of Availability of IRS Documents
Guidance cited in this preamble is published in the Internal
Revenue Bulletin and is available from the Superintendent of Documents,
U.S. Government Publishing Office, Washington, DC 20402, or by visiting
the IRS website at <a href="https://www.irs.gov">https://www.irs.gov</a>.
Drafting Information
The principal author of these final regulations is Clara L. Raymond
of the Office of Associate Chief Counsel (Income Tax and Accounting).
However, other personnel from the Treasury
[[Page 102725]]
Department and the IRS participated in the development of the
regulations.
List of Subjects in 26 CFR Part 1
Income taxes, Reporting and recordkeeping requirements.
Adoption of Amendments to the Regulations
Accordingly, the Treasury Department and the IRS amend 26 CFR part
1 as follows:
PART 1--INCOME TAXES
0
Paragraph 1. The authority citation for part 1 is amended by:
0
1. Removing the entry for Sec. 1.36B-0;
0
2. Adding entries in numerical order for Sec. Sec. 1.36B-1 through
1.36B-3;
0
3. Revising the entries for Sec. Sec. 1.36B-4 and 1.36B-5; and
0
4. Adding an entry in numerical order for Sec. 1.36B-6.
The additions and revisions read as follows:
Authority: 26 U.S.C. 7805 * * *
* * * * *
Section 1.36B-1 also issued under 26 U.S.C. 36B(h).
Section 1.36B-2 also issued under 26 U.S.C. 36B(h).
Section 1.36B-3 also issued under 26 U.S.C. 36B(h).
Section 1.36B-4 also issued under 26 U.S.C. 36B(h).
Section 1.36B-5 also issued under 26 U.S.C. 36B(h).
Section 1.36B-6 also issued under 26 U.S.C. 36B(h).
* * * * *
0
Par. 2. Section 1.36B-0 is amended by:
0
1. Redesignating the entries for Sec. 1.36B-3(c)(4) and Sec. 1.36B-
3(c)(5) as the entries for Sec. 1.36B-3(c)(5) and Sec. 1.36B-3(c)(6),
respectively; and
0
2. Adding a new entry for Sec. 1.36B-3(c)(4).
The addition reads as follows:
Sec. 1.36B-0 Table of contents.
* * * * *
Sec. 1.36B-3 Computing the premium assistance credit amount.
* * * * *
(c) * * *
(4) Scenarios for payments sufficient to avoid coverage
termination.
* * * * *
0
Par. 3. Section 1.36B-2 is amended by:
0
1. Revising the first sentence in paragraph (c)(2)(v);
0
2. Revising paragraph (e)(1); and
0
3. Adding paragraph (e)(6).
The revisions and addition read as follows:
Sec. 1.36B-2 Eligibility for premium tax credit.
* * * * *
(c) * * *
(2) * * *
(v) * * * An individual is treated as not eligible for Medicaid,
CHIP, or a similar program such as a Basic Health Program, for a period
of coverage under a qualified health plan if, when the individual
enrolls in the qualified health plan, an Exchange conducts an
eligibility determination or, if applicable, eligibility assessment
(within the meaning of 45 CFR 155.302(b)) for Medicaid, CHIP, or a
similar program and determines or assesses the individual to be not
eligible for coverage under the program. * * *
* * * * *
(e) * * *
(1) Except as provided in paragraphs (e)(2) through (6) of this
section, this section applies to taxable years ending after December
31, 2013.
* * * * *
(6) The first sentence of paragraph (c)(2)(v) of this section
applies to taxable years beginning on or after January 1, 2025. The
first sentence of paragraph (c)(2)(v) of this section, as contained in
26 CFR part 1 edition revised as of April 1, 2024, applies to taxable
years ending after December 31, 2013, and beginning before January 1,
2025.
0
Par. 4. Section 1.36B-3 is amended by:
0
1. Revising paragraph (c)(1)(ii);
0
2. Redesignating paragraphs (c)(4) and (5) as paragraphs (c)(5) and
(6), respectively;
0
3. Adding new paragraph (c)(4); and
0
4. Revising paragraphs (d)(1)(i) and (n).
The revisions and addition read as follows:
Sec. 1.36B-3 Computing the premium assistance credit amount.
* * * * *
(c) * * *
(1) * * *
(ii) The taxpayer pays the taxpayer's share of the premium for the
individual's coverage under the plan for the month by the unextended
due date for filing the taxpayer's income tax return for that taxable
year, the full premium for the month is paid by advance credit
payments, or the amount of the premium paid (including by advance
credit payments) for the month is sufficient to avoid termination of
the individual's coverage for that month under one of the scenarios
described in paragraph (c)(4) of this section; and
* * * * *
(4) Scenarios for payments sufficient to avoid coverage
termination. The scenarios under which the amount of the premium paid
(including by advance credit payments) for the month is sufficient to
avoid termination of an individual's coverage for that month under
paragraph (c)(1)(ii) of this section are the following:
(i) The first month of a grace period described in 45 CFR
156.270(d) for the individual.
(ii) A month for which a premium payment threshold under 45 CFR
155.400(g) has been met and for which month the issuer of the
individual's qualified health plan provides coverage.
(iii) A month for which a State department of insurance has, during
a declared emergency, issued an order prohibiting the issuer of the
individual's qualified health plan from terminating the individual's
coverage for the month irrespective of whether the full premium for the
month is paid.
* * * * *
(d) * * *
(1) * * *
(i) The enrollment premiums, which are the premiums for the month
for one or more qualified health plans in which a taxpayer or a member
of the taxpayer's family enrolls, reduced by any amounts--
(A) Refunded in the same taxable year as the premium liability is
incurred; or
(B) Unpaid as of the unextended due date for filing the taxpayer's
income tax return for the taxable year that includes the month; or
* * * * *
(n) Applicability dates. (1) Except as provided in paragraphs
(n)(2) through (4) of this section, this section applies to taxable
years ending after December 31, 2013.
(2) Paragraphs (d)(1) (except for paragraph (d)(1)(i)) and (2) of
this section apply to taxable years beginning after December 31, 2016.
Paragraph (f) of this section applies to taxable years beginning after
December 31, 2018. Paragraphs (d)(1) and (2) of Sec. 1.36B-3, as
contained in 26 CFR part 1 edition revised as of April 1, 2016, apply
to taxable years ending after December 31, 2013, and beginning before
January 1, 2017. Paragraph (f) of Sec. 1.36B-3, as contained in 26 CFR
part 1 edition revised as of April 1, 2016, applies to taxable years
ending after December 31, 2013, and beginning before January 1, 2019.
(3) Paragraphs (c)(4) through (6) of this section apply to taxable
years beginning on or after January 1, 2025. Paragraph (c)(4) of this
section, as contained in 26 CFR part 1 edition revised as of April 1,
2024, applies to taxable years beginning after December
[[Page 102726]]
31, 2016, and beginning before January 1, 2025. Paragraph (c)(5) of
this section, as contained in 26 CFR part 1 edition revised as of April
1, 2024, applies to taxable years ending after December 31, 2013, and
beginning before January 1, 2025.
(4) Paragraph (d)(1)(i) of this section applies to taxable years
beginning on or after January 1, 2025. Paragraph (d)(1)(i) of Sec.
1.36B-3, as contained in 26 CFR part 1 edition revised as of April 1,
2016, applies to taxable years ending after December 31, 2013, and
beginning before January 1, 2017. Paragraph (d)(1)(i) of Sec. 1.36B-3,
as contained in 26 CFR part 1 edition revised as of April 1, 2022,
applies to taxable years beginning after December 31, 2016, and
beginning before January 1, 2023. Paragraph (d)(1)(i) of Sec. 1.36B-3,
as contained in 26 CFR part 1 edition revised as of April 1, 2024,
applies to taxable years beginning after December 31, 2022, and
beginning before January 1, 2025.
Douglas W. O'Donnell,
Deputy Commissioner.
Approved: December 5, 2024.
Aviva R. Aron-Dine,
Deputy Assistant Secretary of the Treasury (Tax Policy).
[FR Doc. 2024-29651 Filed 12-17-24; 8:45 am]
BILLING CODE 4830-01-P
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</html>Indexed from Federal Register on December 18, 2024.
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