Other terms and rules relating to premium assistance amounts

6 rules

For purposes of paragraph (2)—

(A) Applicable percentage (i) In general Except as provided in clause (ii), the applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier:

In the case of household income (expressed as a percent of poverty line) within the following income tier:	The initial premium percentage is—	The final premium percentage is—
Up to 133%	2.0%	2.0%
133% up to 150%	3.0%	4.0%
150% up to 200%	4.0%	6.3%
200% up to 250%	6.3%	8.05%
250% up to 300%	8.05%	9.5%
300% up to 400%	9.5%	9.5%.

(ii) Indexing (I) In general Subject to subclause (II), in the case of taxable years beginning in any calendar year after 2014, the initial and final applicable percentages under clause (i) (as in effect for the preceding calendar year after application of this clause) shall be adjusted to reflect the excess of the rate of premium growth for the preceding calendar year over the rate of income growth for the preceding calendar year. (II) Additional adjustment Except as provided in subclause (III), in the case of any calendar year after 2018, the percentages described in subclause (I) shall, in addition to the adjustment under subclause (I), be adjusted to reflect the excess (if any) of the rate of premium growth estimated under subclause (I) for the preceding calendar year over the rate of growth in the consumer price index for the preceding calendar year. (III) Failsafe Subclause (II) shall apply for any calendar year only if the aggregate amount of premium tax credits under this section and cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act for the preceding calendar year exceeds an amount equal to 0.504 percent of the gross domestic product for the preceding calendar year. (iii) Temporary percentages for 2021 through 2025 In the case of a taxable year beginning after December 31, 2020 , and before January 1, 2026 — (I) clause (ii) shall not apply for purposes of adjusting premium percentages under this subparagraph, and (II) the following table shall be applied in lieu of the table contained in clause (i):

In the case of household income (expressed as a percent of poverty line) within the following income tier:	The initial premium percentage is—	The final premium percentage is—
Up to 150.0 percent	0.0	0.0
150.0 percent up to 200.0 percent	0.0	2.0
200.0 percent up to 250.0 percent	2.0	4.0
250.0 percent up to 300.0 percent	4.0	6.0
300.0 percent up to 400.0 percent	6.0	8.5
400.0 percent and higher	8.5	8.5

(B) Applicable second lowest cost silver plan The applicable second lowest cost silver plan with respect to any applicable taxpayer is the second lowest cost silver plan of the individual market in the rating area in which the taxpayer resides which— (i) is offered through the same Exchange through which the qualified health plans taken into account under paragraph (2)(A) were offered, and (ii) provides— (I) self-only coverage in the case of an applicable taxpayer— (aa) whose tax for the taxable year is determined under section 1(c) 2 2 See References in Text note below. (relating to unmarried individuals other than surviving spouses and heads of households) and who is not allowed a deduction under section 151 for the taxable year with respect to a dependent, or (bb) who is not described in item (aa) but who purchases only self-only coverage, and (II) family coverage in the case of any other applicable taxpayer. If a taxpayer files a joint return and no credit is allowed under this section with respect to 1 of the spouses by reason of subsection (e), the taxpayer shall be treated as described in clause (ii)(I) unless a deduction is allowed under section 151 for the taxable year with respect to a dependent other than either spouse and subsection (e) does not apply to the dependent.

(C) Adjusted monthly premium The adjusted monthly premium for an applicable second lowest cost silver plan is the monthly premium which would have been charged (for the rating area with respect to which the premiums under paragraph (2)(A) were determined) for the plan if each individual covered under a qualified health plan taken into account under paragraph (2)(A) were covered by such silver plan and the premium was adjusted only for the age of each such individual in the manner allowed under section 2701 of the Public Health Service Act. In the case of a State participating in the wellness discount demonstration project under section 2705(d) of the Public Health Service Act, the adjusted monthly premium shall be determined without regard to any premium discount or rebate under such project.

(D) Additional benefits If— (i) a qualified health plan under section 1302(b)(5) of the Patient Protection and Affordable Care Act offers benefits in addition to the essential health benefits required to be provided by the plan, or (ii) a State requires a qualified health plan under section 1311(d)(3)(B) of such Act to cover benefits in addition to the essential health benefits required to be provided by the plan, the portion of the premium for the plan properly allocable (under rules prescribed by the Secretary of Health and Human Services) to such additional benefits shall not be taken into account in determining either the monthly premium or the adjusted monthly premium under paragraph (2).

(E) Special rule for pediatric dental coverage For purposes of determining the amount of any monthly premium, if an individual enrolls in both a qualified health plan and a plan described in section 1311(d)(2)(B)(ii)(I) 2 of the Patient Protection and Affordable Care Act for any plan year, the portion of the premium for the plan described in such section that (under regulations prescribed by the Secretary) is properly allocable to pediatric dental benefits which are included in the essential health benefits required to be provided by a qualified health plan under section 1302(b)(1)(J) of such Act shall be treated as a premium payable for a qualified health plan.

In the case of household income (expressed as a percent of poverty line) within the following income tier:

The initial premium percentage is—

The final premium percentage is—

Up to 133%

2.0%

133% up to 150%

3.0%

4.0%

150% up to 200%

4.0%

6.3%

200% up to 250%

6.3%

8.05%

250% up to 300%

8.05%

9.5%

300% up to 400%

9.5%

9.5%.

In the case of household income (expressed as a percent of poverty line) within the following income tier:

The initial premium percentage is—

The final premium percentage is—

Up to 150.0 percent

0.0

150.0 percent up to 200.0 percent

0.0

2.0

200.0 percent up to 250.0 percent

2.0

4.0

250.0 percent up to 300.0 percent

4.0

6.0

300.0 percent up to 400.0 percent

6.0

8.5

400.0 percent and higher

8.5

name: applicable_percentage_income_tier kind: derived entity: TaxUnit dtype: Integer period: Year source: 26 USC 36B(b)(3)(A)(i), applicable percentage table metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/26/36B excerpt: >- household income (expressed as a percent of poverty line) within the following income tier - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#applicable_percentage_tier_upper_bound output: applicable_percentage_tier_upper_bound hash: sha256:local versions: - effective_from: '1990-01-01' formula: >- if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[0]: 0 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[1]: 1 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[2]: 2 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[3]: 3 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[4]: 4 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[5]: 5 else: -1

name: applicable_percentage_tier_lower_bound kind: parameter dtype: Decimal indexed_by: applicable_percentage_income_tier source: 26 USC 36B(b)(3)(A)(i), income tier row labels metadata: proof: atoms: - path: versions[0].values kind: parameter_table source: corpus_citation_path: us/statute/26/36B excerpt: >- 133% up to 150%; 150% up to 200%; 200% up to 250%; 250% up to 300%; 300% up to 400% table: header: applicable percentage table row_key: household income expressed as percent of poverty line income tier column_key: income tier lower bound versions: - effective_from: '1990-01-01' values: '1': 1.33 '2': 1.5 '3': 2 '4': 2.5 '5': 3

name: applicable_percentage_tier_upper_bound kind: parameter dtype: Decimal indexed_by: applicable_percentage_income_tier source: 26 USC 36B(b)(3)(A)(i), income tier row labels metadata: proof: atoms: - path: versions[0].values kind: parameter_table source: corpus_citation_path: us/statute/26/36B excerpt: >- Up to 133%; 133% up to 150%; 150% up to 200%; 200% up to 250%; 250% up to 300%; 300% up to 400% table: header: applicable percentage table row_key: household income expressed as percent of poverty line income tier column_key: income tier upper bound versions: - effective_from: '1990-01-01' values: '0': 1.33 '1': 1.5 '2': 2 '3': 2.5 '4': 3 '5': 4

name: initial_premium_percentage_by_income_tier kind: parameter dtype: Rate indexed_by: applicable_percentage_income_tier source: 26 USC 36B(b)(3)(A)(i), initial premium percentage column metadata: proof: atoms: - path: versions[0].values kind: parameter_table source: corpus_citation_path: us/statute/26/36B excerpt: >- The initial premium percentage is— 2.0%, 3.0%, 4.0%, 6.3%, 8.05%, 9.5% table: header: applicable percentage table row_key: household income expressed as percent of poverty line income tier column_key: initial premium percentage versions: - effective_from: '1990-01-01' values: '0': 0.02 '1': 0.03 '2': 0.04 '3': 0.063 '4': 0.0805 '5': 0.095

name: final_premium_percentage_by_income_tier kind: parameter dtype: Rate indexed_by: applicable_percentage_income_tier source: 26 USC 36B(b)(3)(A)(i), final premium percentage column metadata: proof: atoms: - path: versions[0].values kind: parameter_table source: corpus_citation_path: us/statute/26/36B excerpt: The final premium percentage is— 2.0%, 4.0%, 6.3%, 8.05%, 9.5%, 9.5% table: header: applicable percentage table row_key: household income expressed as percent of poverty line income tier column_key: final premium percentage versions: - effective_from: '1990-01-01' values: '0': 0.02 '1': 0.04 '2': 0.063 '3': 0.0805 '4': 0.095 '5': 0.095

name: applicable_percentage kind: derived entity: TaxUnit dtype: Rate period: Year source: 26 USC 36B(b)(3)(A)(i) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/26/36B excerpt: >- shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#applicable_percentage_income_tier output: applicable_percentage_income_tier hash: sha256:local - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#applicable_percentage_tier_lower_bound output: applicable_percentage_tier_lower_bound hash: sha256:local - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#applicable_percentage_tier_upper_bound output: applicable_percentage_tier_upper_bound hash: sha256:local - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#initial_premium_percentage_by_income_tier output: initial_premium_percentage_by_income_tier hash: sha256:local - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#final_premium_percentage_by_income_tier output: final_premium_percentage_by_income_tier hash: sha256:local versions: - effective_from: '1990-01-01' formula: >- if applicable_percentage_income_tier == -1: 0 else: if applicable_percentage_income_tier == 0: initial_premium_percentage_by_income_tier[applicable_percentage_income_tier] else: initial_premium_percentage_by_income_tier[applicable_percentage_income_tier] + ((household_income_as_percent_of_poverty_line - applicable_percentage_tier_lower_bound[applicable_percentage_income_tier]) / (applicable_percentage_tier_upper_bound[applicable_percentage_income_tier] - applicable_percentage_tier_lower_bound[applicable_percentage_income_tier])) * (final_premium_percentage_by_income_tier[applicable_percentage_income_tier] - initial_premium_percentage_by_income_tier[applicable_percentage_income_tier])

- name: applicable_percentage_income_tier kind: derived entity: TaxUnit dtype: Integer period: Year source: 26 USC 36B(b)(3)(A)(i), applicable percentage table metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/26/36B excerpt: >- household income (expressed as a percent of poverty line) within the following income tier - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#applicable_percentage_tier_upper_bound output: applicable_percentage_tier_upper_bound hash: sha256:local versions: - effective_from: '1990-01-01' formula: >- if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[0]: 0 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[1]: 1 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[2]: 2 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[3]: 3 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[4]: 4 else: if household_income_as_percent_of_poverty_line <= applicable_percentage_tier_upper_bound[5]: 5 else: -1

- name: applicable_percentage_tier_lower_bound kind: parameter dtype: Decimal indexed_by: applicable_percentage_income_tier source: 26 USC 36B(b)(3)(A)(i), income tier row labels metadata: proof: atoms: - path: versions[0].values kind: parameter_table source: corpus_citation_path: us/statute/26/36B excerpt: 133% up to 150%; 150% up to 200%; 200% up to 250%; 250% up to 300%; 300% up to 400% table: header: applicable percentage table row_key: household income expressed as percent of poverty line income tier column_key: income tier lower bound versions: - effective_from: '1990-01-01' values: '1': 1.33 '2': 1.5 '3': 2 '4': 2.5 '5': 3

- name: applicable_percentage_tier_upper_bound kind: parameter dtype: Decimal indexed_by: applicable_percentage_income_tier source: 26 USC 36B(b)(3)(A)(i), income tier row labels metadata: proof: atoms: - path: versions[0].values kind: parameter_table source: corpus_citation_path: us/statute/26/36B excerpt: >- Up to 133%; 133% up to 150%; 150% up to 200%; 200% up to 250%; 250% up to 300%; 300% up to 400% table: header: applicable percentage table row_key: household income expressed as percent of poverty line income tier column_key: income tier upper bound versions: - effective_from: '1990-01-01' values: '0': 1.33 '1': 1.5 '2': 2 '3': 2.5 '4': 3 '5': 4

- name: initial_premium_percentage_by_income_tier kind: parameter dtype: Rate indexed_by: applicable_percentage_income_tier source: 26 USC 36B(b)(3)(A)(i), initial premium percentage column metadata: proof: atoms: - path: versions[0].values kind: parameter_table source: corpus_citation_path: us/statute/26/36B excerpt: The initial premium percentage is— 2.0%, 3.0%, 4.0%, 6.3%, 8.05%, 9.5% table: header: applicable percentage table row_key: household income expressed as percent of poverty line income tier column_key: initial premium percentage versions: - effective_from: '1990-01-01' values: '0': 0.02 '1': 0.03 '2': 0.04 '3': 0.063 '4': 0.0805 '5': 0.095

- name: final_premium_percentage_by_income_tier kind: parameter dtype: Rate indexed_by: applicable_percentage_income_tier source: 26 USC 36B(b)(3)(A)(i), final premium percentage column metadata: proof: atoms: - path: versions[0].values kind: parameter_table source: corpus_citation_path: us/statute/26/36B excerpt: The final premium percentage is— 2.0%, 4.0%, 6.3%, 8.05%, 9.5%, 9.5% table: header: applicable percentage table row_key: household income expressed as percent of poverty line income tier column_key: final premium percentage versions: - effective_from: '1990-01-01' values: '0': 0.02 '1': 0.04 '2': 0.063 '3': 0.0805 '4': 0.095 '5': 0.095

- name: applicable_percentage kind: derived entity: TaxUnit dtype: Rate period: Year source: 26 USC 36B(b)(3)(A)(i) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/26/36B excerpt: >- shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#applicable_percentage_income_tier output: applicable_percentage_income_tier hash: sha256:local - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#applicable_percentage_tier_lower_bound output: applicable_percentage_tier_lower_bound hash: sha256:local - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#applicable_percentage_tier_upper_bound output: applicable_percentage_tier_upper_bound hash: sha256:local - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#initial_premium_percentage_by_income_tier output: initial_premium_percentage_by_income_tier hash: sha256:local - path: versions[0].formula kind: import import: target: us:statutes/26/36B/b/3/A#final_premium_percentage_by_income_tier output: final_premium_percentage_by_income_tier hash: sha256:local versions: - effective_from: '1990-01-01' formula: >- if applicable_percentage_income_tier == -1: 0 else: if applicable_percentage_income_tier == 0: initial_premium_percentage_by_income_tier[applicable_percentage_income_tier] else: initial_premium_percentage_by_income_tier[applicable_percentage_income_tier] + ((household_income_as_percent_of_poverty_line - applicable_percentage_tier_lower_bound[applicable_percentage_income_tier]) / (applicable_percentage_tier_upper_bound[applicable_percentage_income_tier] - applicable_percentage_tier_lower_bound[applicable_percentage_income_tier])) * (final_premium_percentage_by_income_tier[applicable_percentage_income_tier] - initial_premium_percentage_by_income_tier[applicable_percentage_income_tier])