Six situations, and what to do with each one.
One entry per situation. What changed, what to check, and when to send it over. Written to be used in the meeting, not read afterward.
400% of the federal poverty level for 2027 coverage is $63,840 for a single filer and $132,000 for a family of four, per KFF and IRS. Reviewed October 2026.
01Above the subsidy cliff and under 65For 2027 coverage, 400% of FPL is $63,840 single and $132,000 for a family of four.
What changed
The enhanced premium tax credits expired in December 2025. For 2027 coverage, a household above 400% of the federal poverty level receives no premium tax credit. Not a reduced credit. None. For a single filer that line is $63,840. For a family of four it is $132,000.
What to check
MAGI against the line before a Roth conversion, a gain, or a retirement date lands for anyone under 65. Health insurance is a variable in that model whether or not it is in the spreadsheet. Put the health line in first, then size the rest.
The timing trap
Most clients who get hit are not high income. They are near the line and something lands in December: a bonus, a capital gain, a distribution. The credit is reconciled on Form 8962 at filing, so the whole year's worth comes back on the return you prepare, and you are the one who explains it.
Send it over if
They are above 400% FPL and under 65. Send them over and we will review options.
Send these too
They are under the line and receiving a credit. Send them over and we will review options. Do not decide the outcome from the return.
02Just went 1099, or has been for yearsNo group plan, no open enrollment email, and the premium is a line on the return you already see.
What changed
Nothing on a schedule. That is the problem. There is no HR department and no renewal notice, so whatever the client set up when they went independent is usually still what they have. You see it every year on the self-employed health insurance deduction. Nobody else does.
What to check
What they are on now: COBRA and when it ends, a marketplace plan and whether a credit is attached, or nothing at all. The deductible. Whether the household income sits near the 400% line.
Worth knowing
The long-time 1099 client who already has a plan is easy to skip, because it renewed on its own. Send them over and we will review options.
Send it over if
They are 1099 or self-employed, COBRA is ending, they are on a marketplace plan, or they have been going without. Send them over and we will review options.
Send these too
They are receiving a credit, or there is a medical condition. Send them over and we will review options. Do not decide the outcome from the return.
03The owner deciding between a group plan and individual coverageThe question comes up at hiring and at renewal.
What changed
Owners ask at hiring and at renewal whether the household should be on a group plan or on coverage of its own. Group and individual are different products. Who would enroll is the question to write down, not a conclusion to reach in the meeting.
What to check
Headcount. How many employees would take coverage if offered. What the owner and the owner's family are on today. The renewal letter, if there is one.
Worth knowing
Send them over, we can review group options.
Send it over if
The owner and their family are on individual coverage or have nothing, or the business would struggle without the owner and there is no disability coverage or life coverage on the owner. Send them over, we can review group options.
Send these too
A group plan is already in place. If you are unsure whether it still fits, send them over, we can review group options.
04Retiring before MedicareThe bridge from the retirement date to 65.
What changed
The years between a retirement date and Medicare need their own health plan when there is no group coverage. Income in those years, including a conversion or a gain, can move the household across 400% of the federal poverty level.
What to check
The retirement date against 65 for each spouse. What income lands in the bridge years: conversions, gains, pension start dates, Social Security timing. Whether either spouse has group coverage that can carry both of them.
The number that hides
Two spouses with different birthdays can have a bridge that is two years for one and five for the other. Note the longer one, then send them over and we will review options.
Send it over if
They are under 65 and there is no group plan. Send them over and we will review options.
Send these too
A spouse's group plan covers them, or they are under 400% FPL with a credit. If you are unsure, send them over and we will review options.
05The deductible nobody can absorbA bill the household cannot pay can show up on the return.
What changed
A deductible the household cannot pay can force a distribution. Near 400% of the federal poverty level, that distribution can change the return.
What to check
The deductible against the cash reserve, and whether a surprise bill would force a distribution.
Worth knowing
Send them over and we will review options. We will not assume the current plan has to be replaced.
Send it over if
There is no reserve set aside for the deductible. Send them over and we will review options.
Send these too
The reserve covers the deductible, or the client has chosen to self-insure. If you are unsure, send them over and we will review options.
06The plan calls for a term policyThe plan assumes the income continues. If it stops, the plan breaks.
What changed
Usually the plan did. A new investment strategy, a mortgage, a second child, a business that grew. The life coverage was bought for an earlier version of the client's life and nobody has stress tested it against this one.
What to check
The coverage amount against what actually needs replacing: years of income, the mortgage, education, and a buy-sell agreement if there is one. We use term, whole life, or indexed universal life for that. The term length against the horizon. Any policy bought before the business grew. Coverage on an owner the business depends on, using one of those same products.
Worth knowing
A term policy that ends before the mortgage does is a common gap, and it stays invisible until the renewal notice arrives.
Send it over if
There is a gap between what the plan needs and what is in force, the term ends before the need does, or the policy has not been reviewed in years. The client can look at term quotes at brandedinsurancegroup.com/life. Or send them over and we will review options.
Send these too
The coverage matches the plan and the term outlasts the need. If you are unsure, send them over and we will review options.
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