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Your premium tax credit is based on the income you project for the coverage year — not last year’s tax return. Here’s what the Marketplace counts, what it doesn’t, and how to estimate well.
The Marketplace generally uses projected Modified Adjusted Gross Income, or MAGI, for your tax household for the year you will be covered. MAGI starts with federal adjusted gross income and adds certain items, including tax-exempt interest, non-taxable Social Security benefits, and excluded foreign income. Depending on how they are treated for federal tax purposes, household income may include wages, net self-employment income, unemployment compensation, retirement income, investment income, and Social Security benefits. Child support, Supplemental Security Income, gifts, and loans generally are not included. Estimating carefully and reporting changes during the year helps keep your premium tax credit accurate.
Insurance Advisors of Florida helps individuals, families, self-employed Floridians, retirees, and small businesses understand potential eligibility for ACA Marketplace coverage and available financial assistance. The Marketplace makes the official eligibility determination.
Marketplace Income at a Glance
| What the Marketplace uses | Projected Modified Adjusted Gross Income (MAGI) for the coverage year |
|---|---|
| Whose income counts | The tax filer, a spouse if applicable, and tax dependents whose income must be included under Marketplace tax-household rules |
| Commonly included | Wages, net self-employment income, unemployment compensation, taxable retirement and investment income, and Social Security benefits included under MAGI rules |
| Generally not counted | Child support, Supplemental Security Income (SSI), gifts, loans, and certain non-taxable benefits |
| Time frame | Your best estimate for the year you will be covered — not last year’s return |
| If your income changes | Report it to the Marketplace to adjust the credit going forward |
| Cost to review your estimate | No additional fee through Insurance Advisors of Florida |
Marketplace savings are based on projected household MAGI for the coverage year, not simply take-home pay, an hourly wage, or one month’s gross income. Modified Adjusted Gross Income (MAGI) is generally your federal adjusted gross income, plus any tax-exempt interest, the non-taxable portion of Social Security benefits, and certain excluded foreign income. For most Florida households, MAGI is the same as, or very close to, adjusted gross income.
This number matters because it drives both eligibility and the size of any premium tax credit. Report too little and you may receive more advance credit than you are entitled to; report too much and your monthly help may be smaller than it could be. If you are still working out whether you qualify at all, start with do I qualify for a subsidy.
The Marketplace looks at your tax household, not everyone under your roof. That generally means the tax filer, a spouse filing jointly, and anyone claimed as a tax dependent. Roommates, adult children who file their own returns and are not your dependents, and other relatives who live with you but are not on your tax return generally are not counted.
Household income for premium-tax-credit purposes generally includes the MAGI of the filer and a spouse filing jointly. A dependent’s MAGI is generally included only when the dependent is required to file a federal income tax return because the dependent meets the applicable filing threshold — a dependent who files only to claim a refund does not automatically have to be counted. Married applicants generally must file jointly to receive the premium tax credit, subject to limited exceptions such as qualifying domestic-abuse or spousal-abandonment relief.
Generally included in Marketplace income:
Generally not counted:
Tax treatment can vary by payment type and individual circumstances, so unusual income sources should be reviewed with a qualified tax professional.
If you are self-employed, a contractor, or a gig worker, estimate your expected net self-employment income — what is left after legitimate allowable business expenses — rather than gross revenue or the total on your 1099s, which are not automatically the Marketplace income figure. A landscaper who invoices $90,000 but spends $35,000 on equipment, fuel, and materials may estimate approximately $55,000 of net self-employment income before considering other federal tax adjustments that may affect MAGI.
A recent tax return or Schedule C is a reasonable baseline, adjusted for how the current year is actually going. Because self-employment income moves around, update the Marketplace estimate when business circumstances change — and give it a mid-year check even when nothing dramatic has. Our self-employed health insurance page covers coverage options for Floridians who work for themselves.
The application asks for an annual figure, so the goal is your best estimate for the whole year — not your slowest month multiplied by twelve, and not your busiest. Seasonal workers should add up what the busy season and the off-season realistically produce together across the year.
If you are receiving unemployment compensation, those benefits generally count as income. When estimating, consider both the benefits you expect to receive and any earnings from work you expect to pick up later in the year. When the picture genuinely cannot be predicted, make a reasonable good-faith estimate and update the application as reality develops.
A practical approach: start with last year’s federal return, then adjust for what you already know about this year — a raise, a job change, a new client, a slower market, benefits starting or ending. Include every category from the “included” list above for every member of the tax household whose income counts.
A simplified educational example:
This is a simplified educational example only. Actual MAGI may differ because of federal tax adjustments, deductions, tax-exempt interest, non-taxable Social Security benefits, or excluded foreign income.
Then put a reminder on the calendar to revisit the number mid-year. Most reconciliation surprises come not from a bad original estimate but from a good estimate that was never updated after circumstances changed.
Your credit is based on a projection, so when income or household circumstances change — up or down — report the change to the Marketplace. Updating your application adjusts the credit going forward, which is the single most effective way to avoid an unexpected difference later.
At tax time, the Marketplace provides Form 1095-A, and IRS Form 8962 is used to claim or reconcile the premium tax credit. If the advance payments were lower than the final allowable credit, you may qualify for additional credit. If they were higher, the excess may increase the amount owed or reduce the refund. For tax years beginning after December 31, 2025, the former income-based limits on repayment of excess advance premium tax credits no longer apply, so a household may be required to repay the full excess amount. Because this is a tax matter, consumers should consult a qualified tax professional about their individual return. Our guide to how premium tax credits work walks through reconciliation in more detail.
Many Florida households have income that can be difficult to project because of seasonal work, tourism, hospitality, construction, agriculture, self-employment, gig work, and weather-related interruptions. Florida has many self-employed, contract, seasonal, and gig workers. Florida’s lack of a state individual income tax changes nothing here — Marketplace income is a federal calculation.
One Florida-specific reality deserves care: because Florida has not expanded Medicaid, households near the lower end of the eligibility range should make an especially careful, reasonable, good-faith estimate, since the projected household income may affect whether the applicant is evaluated for Marketplace financial assistance, Medicaid, or a potential coverage gap under Florida’s current Medicaid eligibility rules. For broader context, see our Florida health insurance subsidies page.
Walking through an income estimate takes a few minutes on the phone. Insurance Advisors of Florida does not charge consumers an additional fee for assistance with eligible Marketplace enrollment, and using an agent does not increase the Marketplace premium or reduce the premium tax credit for which the household qualifies. It is especially worth a call when you are self-employed or your income varies, when your household recently changed, or when you are simply not sure which numbers belong on the application. Licensed agents are not tax preparers — for questions about your tax return itself, a qualified tax professional is the right resource — but an agent can help you understand what the Marketplace application is asking for and review plan options in your area.
Eligibility rules can change from year to year. This article is intended for educational purposes and does not constitute legal or tax advice. A licensed Florida health insurance agent can review your individual situation.
Chad Garrell, MBA/MHA, is VP & Founder of Insurance Advisors of Florida. He has helped Florida residents understand and compare individual, ACA Marketplace, Medicare, and employer health insurance options since founding the agency in 2006. Learn more about Chad and our team.
The Marketplace generally uses Modified Adjusted Gross Income (MAGI) — your adjusted gross income plus any tax-exempt interest, non-taxable Social Security benefits, and excluded foreign income. For most households, this generally includes wages, net self-employment income, unemployment compensation, and Social Security benefits.
You report your best estimate of household income for the year you will be covered — not last year’s tax return. Last year’s return is a useful starting point, but the application asks for a projection, which you can update during the year if things change.
Social Security retirement, disability (SSDI), and survivor benefits generally count toward Marketplace income, including any portion that is not taxable. Supplemental Security Income (SSI) generally does not count.
Use your expected net profit — business income minus business expenses — rather than gross revenue. A recent tax return or Schedule C is a reasonable baseline, adjusted for how the current year is actually going. Reviewing the estimate during the year helps keep the credit accurate.
Generally the income of the tax filer, a spouse filing jointly, and any tax dependents who are required to file their own return. A dependent’s income that falls below the filing requirement generally does not count.
Any advance premium tax credit is reconciled on your federal tax return using Form 1095-A and IRS Form 8962. If the advance payments were lower than the final allowable credit, you may qualify for additional credit; if they were higher, the excess may increase the amount owed or reduce the refund. For tax years beginning after December 31, 2025, the former income-based repayment limits no longer apply, so consult a qualified tax professional about your individual return.
Still have questions? Call a licensed Florida agent →
Continue through the ACA Marketplace Knowledge Center, or see all topics.
How household income and size determine premium tax credit eligibility in Florida.
Read the article →How the credit is calculated from the benchmark plan and your expected contribution — and what happens at tax time.
Read the article →What actually determines Marketplace eligibility in Florida — and what doesn’t.
Read the article →Browse every ACA Marketplace guide — subsidies, enrollment, plan types, and costs.
See all topics →A licensed Florida agent can walk through your income estimate with you and review what you may qualify for — in plain English, with no additional agency fee. No pressure. No obligation.
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