Healthcare Insurance Subsidies Explained

Young family looking at healthcare insurance subsidies
Healthcare Insurance Subsidies Are Complicated

Healthcare insurance subsidies are complicated. Knowing what to do and how to maximize payments and discounts sometimes needs expert help.

By applying through the Federal Healthcare Insurance marketplace, you may qualify for Advanced Premium Tax Credits (APTC).

These can be premium subsidies and/or cost subsidies depending on where your annual household income and family size fall on the Federal Poverty Level (FPL) chart.  The chart below is based on the annual income for subsidies. Listed are income levels for 2017.

Family Size 138% 250% 400%
1 $16,243 $29,425 $47,080
2 $21,983 $39,825 $63,720
3 $27,724 $50,225 $80,360
4 $33,465 $60,625 $97,000

To use the above chart to determine if you may be eligible for healthcare insurance premium payment assistance, count the number of individuals in your taxable household, then calculate your total taxable income for the household.

  • Under 400% of poverty level, then you may be eligible for healthcare insurance premium subsidies.
  • Under 250% of poverty level, then you may be eligible for healthcare insurance premium subsidies AND cost subsidies.
  • Under 138% of poverty level, then you may be eligible for Medicaid. Medicaid is free no-cost health care.

States vary on whether or not they have expanded Medicaid.  Since it is a state based program, coverage will vary based on what they provide if you are eligible for Medicaid.  Currently in Kentucky (2017), the entire Medicaid program is undergoing an overhaul. We are continually informed as to the changes that are taking place as they happen in order to best assist you.

Understanding Healthcare Insurance Subsidies

There are two types of subsidies. Below is an explanation of each and who is eligible for each.

• Premium subsidies are monies paid by the government directly to your insurance carrier and they reduce your monthly premium by a certain amount. Your subsidy amount depends on your household size and income. Premium subsidies are available for people who earn up to 400% of the Federal Poverty Level (FPL).

• Cost subsidies lower deductibles and copays for your healthcare plan. For example, a healthcare plan without cost subsidies may have a $2,500 deductible. If you are eligible for cost subsidies, your deductible may be lowered to $750 on the same plan. The copay you pay at the doctor may be lower as well. Cost subsidies are available for people who earn up to 250% of the FPL.

Are You Eligible for Cost or Premium Subsidies for Your Healthcare?

Entering your information into the healthcare insurance marketplace to determine if you are eligible for discounts is how you find out and receive the subsidies or cost discounts. You must file taxes to be eligible to receive them.

Where we find the many of the issues for clients, is if you are self-employed or if you have your own business.  Ensuring you enter the information correctly can really affect what you pay in your healthcare insurance premium.

We Are the Healthcare Insurance Experts

We are experts in healthcare insurance and healthcare insurance subsidies and premium discounts. Once you have created your account online in the healthcare marketplace, we can help you enter the information to ensure you are properly maximizing your potential discounts and savings.  Additionally, we are available to help you pick the plan that is the best for your needs and for your family.

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