H.R. 1: A Section-by-Section Look at Key Changes
Section 71301 — Elimination of Marketplace Premium Tax Credit (PTC) Eligibility for Certain Lawfully Present Immigrants, Effective Jan. 1, 2027
Beginning in 2027, APTC and cost-sharing reduction (CSR) subsidies will no longer be available to all lawfully present non-citizens other than:
- Lawful permanent residents (known as green card holders)
- Certain Cuban and Haitian migrants
- Individuals from the Marshall Islands, the Federated States of Micronesia and the Republic of Palau, who live and work in the U.S. under the Compact of Free Association (COFA)
Lawfully present individuals who have previously been eligible for APTC and CSR subsidies but will lose eligibility in 2027 include refugees, those who have been approved for asylum, valid visa holders and people with temporary protected status.
Section 71302 — Elimination of Marketplace Premium Tax Credit Eligibility for Certain Lawfully Present Immigrants Ineligible for Medicaid, Effective Jan. 1, 2026
Beginning this year, lawfully present immigrants, including lawful permanent residents, with household incomes below 100 percent of the federal poverty level (FPL) and ineligible for Medicaid (based on their immigration status), are no longer eligible for APTC.
Section 71303 — Elimination of Provisional Eligibility, Elimination of Marketplace Auto Re-Enrollment, and Ineligibility When Failing to File and Reconcile Prior Year APTC Tax Forms, Effective Jan. 1, 2028
This section of the law will make several changes to the marketplace enrollment process. Beginning in 2028, consumers must actively verify at the time they apply for coverage their:
- Household income and family size
- Immigration status
- Health coverage status or eligibility for other coverage
- Place of residence
- Any other information required by the U.S. Department of the Treasury
Under the new law, this information must be verified by the marketplace using the information provided by the consumer before they can enroll in coverage and become eligible for APTC. Currently, the marketplace offers provisional coverage and APTC to new applicants based on the marketplace’s real-time determination of an applicant’s income and other information using federal and state databases. If additional information is required to confirm eligibility, the marketplace may extend provisional eligibility for up to 90 days to allow the applicant to provide the information requested. The new law ends this provisional eligibility practice in 2028 but provides for one exception to this process to allow the marketplace to provide provisional eligibility for applicants enrolling through a special enrollment period due to a change in family size, such as a birth or adoption.
For plan year 2028, the new law will also prohibit individuals from being automatically re-enrolled in the same plan (or a similar plan) they were enrolled in for the previous plan year. Individuals will be required to return to their marketplace account and actively update and verify their eligibility information before the end of the open enrollment period and will be ineligible for APTC if they fail to do so.
This section also requires all marketplaces to deny APTC to individuals who fail to file their required tax returns and reconcile the APTC received for the prior year. Under previous rules, enrollees who failed to file and reconcile their APTC had up to two years to submit the required forms. Under the new law, that period has been shortened to one year.
Section 71304 — Elimination of Certain Marketplace Special Enrollment Periods, Effective Jan. 1, 2026
For 2026, H.R. 1 prohibits individuals from receiving APTC and CSR subsidies if they enroll in a health plan during a special enrollment period (SEP) based solely on the relationship between the individual’s household income and the federal poverty level (FPL). Individuals in this group will still be eligible to enroll in marketplace coverage during the regular open enrollment period and receive APTC and CSR subsidies if they otherwise qualify or if they qualify for a SEP based on loss of coverage, marriage, childbirth or other qualifying event.
Section 71305 — Removal of Limitations on Repayment of Premium Tax Credits, Effective Jan. 1, 2026
For the 2026 tax year, the new law removed the cap on the amount that consumers must repay if the APTC they receive is more than they should have received based on their actual income. For 2025, repayment was capped at $375 for single filers with household incomes below 200 percent FPL and increased up to $1,625 for single filers with household incomes below 400 percent FPL. The new law allows the full amount of any excess payment, regardless of household income, to be recaptured.
