This worksheet helps you prepare an income estimate for a Marketplace application. Copy it to paper or a private document; there is nothing to submit on this page. It is not a certified tax calculation, eligibility decision, or tax-return preparation service. Guidance was checked November 2, 2026. Use rules for the coverage year you enter, including that year's tax filing requirements.
1. Set the year and household
- Coverage year: ______. Estimate prepared on: ______.
- Expected tax filer, spouse if applicable, and dependents: ______.
- People applying for coverage: ______.
- Dependents whose income must be included under filing rules: ______.
- Questions about filing status or dependency: ______.
Consult the official household instructions for exceptions. Household membership and whether a dependent's income counts are separate questions. A dependent filing only to obtain a refund is not necessarily required to file. Do not use an old year's filing threshold for a new coverage-year estimate.
2. Build each person's expected annual income
Create one line for each relevant income source using these fields:
- Person and income type: ______.
- Amount already received this year: ______.
- Expected remaining amount: ______.
- Basis for estimate, document, and date: ______.
- Expected annual amount: ______.
Review what income to include for wages, net self-employment earnings, taxable investment income, capital gains, unemployment compensation, retirement income, Social Security, and other items relevant to you. Count the appropriate taxable amount rather than assuming every deposit is income. Do not include child support or Supplemental Security Income as Marketplace income.
For a future coverage year, use expected work hours, rates, contracts, and known changes rather than pretending you already have year-to-date earnings. Last year's return can anchor the estimate, but it cannot reflect a new job, retirement, or business change by itself.
3. Separate business revenue from net earnings
For each business or freelance activity, record:
- Expected revenue: ______.
- Expected deductible business expenses, supported by records: ______.
- Estimated net earnings and remaining uncertainties: ______.
HealthCare.gov's self-employed guidance uses expected net self-employment income for the coverage year. Gross sales and personal withdrawals are not interchangeable with net earnings. Do not subtract business expenses again after starting with a net figure. Obtain tax assistance for uncertain deductions or the interaction between the self-employed health insurance deduction and premium tax credit.
4. Estimate AGI, then identify Marketplace MAGI additions
Use the official income estimation sequence. Starting from an expected adjusted gross income requires accounting for the income and allowable adjustments relevant to your tax situation. Do not subtract a standard deduction or itemized deductions as though they reduce AGI.
Record:
- Expected adjusted gross income for each included person: ______.
- Tax-exempt interest not already included: ______.
- Nontaxable Social Security or applicable railroad retirement amounts not already included: ______.
- Excluded foreign income amounts relevant to Marketplace MAGI: ______.
- Estimated Marketplace MAGI after applicable additions: ______.
Avoid counting the same Social Security or foreign income twice. Add only amounts excluded from the AGI starting figure. For many households MAGI is close to AGI, but similarity is not a reason to skip checking the additions.
5. Assemble the household estimate
Combine the applicable MAGI amounts for the tax filer, spouse, and dependents whose income must be included. Keep a note explaining inclusion or exclusion of each person's income.
- Household annual estimate for the coverage year: ______.
- Current monthly income if the application requests it: ______.
- Lowest and highest plausible annual outcomes for planning: ______.
- Best supported estimate selected and why: ______.
A planning range helps identify uncertainty; the application still needs the requested estimate. Do not choose an amount merely to reach a desired subsidy. Review the premium tax credit guide for the broader eligibility context.
6. Set update and tax-reconciliation reminders
Schedule a review after changes in earnings, household composition, or other coverage, and after a significant business or investment event. Save the previous estimate and explain each revision. Report relevant changes to the Marketplace promptly.
- Next review date or trigger: ______.
- Marketplace update date and confirmation: ______.
- Tax records to retain, including Marketplace Form 1095-A when issued: ______.
The IRS premium tax credit instructions explain the credit and annual reconciliation. Advance credits can differ from the final allowable amount. Keep current-year guidance with your records; this worksheet does not estimate a refund, guarantee assistance, or calculate a repayment cap.