What's my Subsidy
Members who qualify for APTC's and State subsidies
Who are ConnectorCare
The percentage of FPL that household income level must be below, in order to qualify for subsidies in 2026.
What is 400%
These involve document proofing requests for income, residency, and other verification and can cause cancellation if not addressed
What are RFI's
Administrative closure used when a members death is being reported by someone other than the Social Security Administration
What is Code 49?
During renewal time, discrepancies between member information and these records can affect APTC eligibility.
What are IRS records?
Members whose incomes are above 500% of FPL with plan cost of more than 9.3% of household income
Who are APTC-Only
A tax filing status for married members that makes them eligible for subsidies, unless they qualify for an exception (victim of DV or spousal abandonment)
What is married filing jointly
One of the first things a Tier 1 agent can do to help a member who is trying to get help with premium costs.
What is update the application?
The Administrative Closure used for a member who is not a resident of Massachusetts or whose whereabouts are unknown
What is Code 48?
The tax status that members separated from their spouses must file as to be eligible for APTC's
What is Head of Household?
These members qualify for an APTC of $0 dollars and pay the full premium.
Who are Unsubsidized
Government sponsored insurance that prevent access to subsidies for Health Connector plans
What is Medicare, Tricare, VA, Peace Corp or Medicaid
The area in HIX that Tier 1 agents can look to find out if a Administrative Closure has been placed on the account.
What is Notifications on the Dashboard?
Administrative Closure used when a member is "No longer in household". Can only be removed, not applied
What is Code 12?
Beginning in 2014, families who enroll in health insurance through a state or federal marketplace were eligible for these.
What are Advance Premium Tax Credits
In 2026 this category of eligibility for members over 500% of FPL will no longer be available
What is APTC only
Members must not have access to this, that meets minimum value standards, to be eligible for subsidies
What is an ESI or Employer Sponsored Insurance
The status of members who have lived in the United States for more than 5 years as a QAB, Qualified Alien Barred, and are no longer eligible for ConnectorCare
What is QLP or Qualified Lawfully Present
It applies when a member is not the head of household (HOH), has no dependents, and wishes to end their own coverage. Tier 1 Agents must get Escalations Agents to apply or remove
What is Code 38, or Voluntary Withdrawal?
An individual's adjusted gross income, after taking into account certain allowable deductions and tax penalties that is used in determining eligibility.
What is the MAGI, or Modified Adjusted Gross Income?
Many members receive subsidies, including APTC's, to pay for their health plans as part of this federal law
What is the the Affordable Care Act
Income eligibility is based on this, per household, as a percentage of the Federal Poverty Level
What is MAGI or Modified Gross Income
If these are not reconciled, they can cause a member to no longer be eligible for subsidies.
What are prior year APTC's
Although this closure can technically be removed, it will continue to reappear during every data match and re-submission of eligibility unless the member resolves the issue with the Social Security Administration.
What is S7, member death based on data match with SSA
This is the name we were told NOT to use for the Affordable Care Act.
What is ObamaCare?