IRS to Offer Automatic Enrollment in Zero-Premium Health Plans Starting 2028: How Your Tax Return Becomes Your Health Application

This legislation, aptly named the Easy Enrollment in Health Care Act, is designed to fundamentally change how people sign up for affordable health coverage, like Medicaid, CHIP, and ACA marketplace subsidies. Starting in 2028, when you file your federal income taxes, you’ll have the option to consent to the IRS sharing your income data with the Health Insurance Exchanges. If you agree, the system will automatically check if you or anyone in your household qualifies for a zero-net-premium health plan—meaning a plan that costs you nothing out of pocket after subsidies—and enroll you, unless you opt out.

The Tax Filing Shortcut

Think of this as the ultimate 'set it and forget it' button for health insurance eligibility. Right now, applying for subsidies or Medicaid often means a separate, lengthy application process with the Exchange, followed by verification requests. Under this bill (Sec. 3), if you consent when filing your taxes, the IRS will send the necessary income and household data directly to the Exchange. If you qualify for a $0 premium plan, the Exchange will automatically enroll you. You will still need to submit a short supplemental form to confirm details like your state of residence, date of birth, and employer coverage status, but crucially, this form cannot ask about citizenship, immigration, or health status, simplifying the process significantly.

Who Gets the Automatic Enrollment?

This automatic enrollment feature is a game-changer for those who qualify for free coverage (Sec. 4). If the Exchange determines you qualify for a zero-net-premium Qualified Health Plan (QHP) and you don't actively choose a different plan during the special enrollment period, you will be defaulted into one. The Exchange must select a high-value plan—one with the highest actuarial value—as the default. While this is great for ensuring coverage, remember that you will be notified of the default plan and given a specific window to select a different one or opt out entirely. If you miss that deadline, you’re covered, but you might be in a plan you didn't pick, so paying attention to that notification is key.

Less Paperwork, More Data Sharing

For those of us who hate digging up old pay stubs, this bill dramatically reduces the burden of proof (Sec. 5). The law mandates that when determining eligibility for Medicaid or CHIP, states must rely on eligibility findings from other programs like SNAP (food stamps) or TANF (cash assistance), meaning you don't have to re-prove your income status multiple times. Furthermore, to verify income and employer-sponsored coverage, the bill grants health affordability programs access to powerful new data sources, including the National Directory of New Hires (NDNH) (Sec. 6). This means the government can check your wages and whether your employer offers you coverage without asking you to provide a single document, cutting down on administrative hassle and speeding up eligibility decisions. The goal is to use existing, reliable data to verify everything, making the process almost invisible to the applicant.

Income Stability and the 'Best Deal' Rule

One sharp provision deals with income fluctuations early in the year (Sec. 5). If you apply for Medicaid or CHIP between January and April, states can use your income from the previous tax year to determine eligibility. This is helpful for income stability. However, the bill includes a crucial safeguard: if using your current income would result in more assistance (e.g., lower premiums or better cost-sharing), the state must use that current income instead. This ensures that you always get the best deal available, whether your income is trending up or down. If you're a gig worker or have seasonal income, this provision prevents you from being locked into an outdated eligibility level that costs you more money.

The Bottom Line

This Act is a major push for efficiency, leveraging the tax system to cover more people who qualify for free or heavily subsidized health care. While the idea of the IRS sharing your tax data might raise an eyebrow, the consent is voluntary, and the data is strictly limited to determining eligibility and enrollment, with strong privacy rules in place (Sec. 3). For busy working people, this means that filing your taxes could automatically solve your health coverage needs, eliminating a huge administrative headache and ensuring that if you qualify for coverage, you actually get it.