Healthcare Insurance Subsidies Explained

Young family looking at healthcare insurance subsidies
You must file taxes in order to be eligible for subsidies.

By applying through the Federally-Facilitated Marketplace (www.healthcare.gov), you may be eligible for Advanced Premium Tax Credits (APTC), which are subsidies that reduce your premium and/or deductible based on your household income and tax filing status. If you have questions about what qualifies as your “taxable household” you should consult directly with the Help Center of Healthcare.gov.

There are two types of subsidies:
• 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 those who earn up to 400% of the Federal Poverty Level (FPL).

• Cost subsidies lower the deductibles and copays of your healthcare plan and only apply to Silver plans. For example, a healthcare plan without cost subsidies may have a $7,000 deductible. If you are eligible for cost subsidies, your deductible may be reduced to $2,000 on the same plan. The copay you pay at the doctor may be reduced, as well. Cost subsidies are available for those who earn up to 250% of the FPL.

Your eligibility for subsidies depends on where your annual household income and family size fall on the Federal Poverty Level (FPL) chart (2018).  The FPL chart below is based on the annual income limits for subsidies.

Family Size 138% 250% 400%
1 $16,753 $30,350 $48,560
2 $22,715 $41,150 $65,840
3 $28,676 $51,950 $83,120
4 $34,638 $62,750 $100,400

To use the above chart to determine if you may be eligible for APTC or cost subsidies, count the number of individuals in your taxable household, then calculate your total taxable income for the household. If you are:

  • Under 400% of poverty level, then you may be eligible for premium subsidies.
  • Under 250% of poverty level, then you may be eligible for premium subsidies AND cost subsidies.
  • Under 138% of poverty level, then you may be eligible for Medicaid. The Medicaid program varies by state and if you are potentially eligible, the state agency will verify your eligibility and contact you.

 

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

To apply and be eligible for any government subsidies/Advanced Premium Tax Credits, you must apply and enroll through www.healthcare.gov, file taxes and cannot be offered insurance through an employer. If your household income falls under the above limits, you could be eligible for subsidies.

Being able to estimate your income accurately is very important because since premium subsidies are advanced tax credits, these subsidies will reconcile when you file your taxes. If you had higher income than you stated on your application, you will owe on your taxes. Conversely, if your income was lower than anticipated, you may be entitled to a refund of subsidies that you would have been eligible for.

Visit www.Healthcare.gov for assistance

While we can help the non-Meidcare eligible spouse’s of our Medicare-eligible clients navigate this process, we currently do not actively offer assistance with healthcare.gov applications or plan selection.

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