Calculate Modified Adjusted Gross Income without Tax Return

Eligibility for the premium tax credit is calculated based on multiple factors, including your age, tax filing status and projected annual household income. To determine your household income, we use an income calculation method called “Modified Adjusted Gross Income” or MAGI. If you are interested in applying for up-front financial assistance, you will need to provide us with your MAGI. Use this form if you DO NOT have your tax return from last year to help you determine your MAGI for the year in which you are seeking health care coverage.

You can also buy health insurance without applying for financial assistance and, if eligible, claim the tax credit when you file your federal taxes. At tax filing, the IRS is expected to determine your eligibility and provide the tax credit as a refund or reduction on your tax liability.

Use this worksheet when a household has experienced a non-trivial change in circumstances since filing its tax return.
  • Note: that pre-tax contributions to dependent care accounts, health insurance premiums, flexible spending accounts, retirement accounts and commuter expenses are NOT included as income
  • Social Security Disability Insurance (SSDI) is included here. Social Security Income (SSI) income is not included here. If you are receiving SSI, you are automatically eligible for Medicaid in the state of Colorado. You also do not need to include any veterans disability benefits you may receive.
  • Most deductions for self-employed business expenses are included in net income (the profit once business expenses are paid) but additional deductions can be taken for the deductible part of self-employment tax, self-employed SEP, SIMPLE, and qualified plans, and self-employed health insurance deductions. For additional information see IRS Publication 334, Tax Guide for Small Business.
  • Households may be able to deduct a portion of the interest they expect to pay on a qualified student loan. Box 1 of the 1098-E Form shows the interest paid for the prior year, which may be helpful in projecting student loan interest that will be paid during the year.

    Note: IRS deduction limits may be applied to the amounts you entered. The maximum amount you may include for this deduction is $2,500 annually.

  • Note: IRS deduction limits may be applied to the amounts you entered. The maximum amount you may include for this deduction is $6,500 annually.
  • Note: IRS deduction limits may be applied to the amounts you entered. The maximum amount you may include for this deduction is $3,000 annually.