Can I receive a subsidy for my health insurance under the Affordable Care Act?

Possibly.  It depends on your household income and the number of people living with you.

The Affordable Care Act (ACA) includes tax credits or subsidies for individuals and families to use toward qualified health plans found on public exchanges.  Subsidies will be available to qualified individuals and families that have previous reported incomes in the range of 138% to 400% above the Federal Poverty Level.  The below chart shows federal poverty guidelines based on family size:

Eligibility for Premium Tax Credits

Eligibility for the premium tax credit is based on household income and access to minimum essential coverage. The following summarizes the key eligibility standards for premium tax credits (tax credits that reduce the cost of insurance premiums).

You must meet the following criteria to be eligible for a premium tax credit:

  • You are not eligible for minimum essential coverage — including employer-sponsored coverage, Medicaid, CHIP, Medicare, and other forms of coverage — other than through the individual insurance market, unless your employer-sponsored coverage is not affordable or does not provide minimum value (based on by ACA standards).
  • You have an annual household income that is between 100% and 400% of the Federal Poverty Level (FPL), or below 100% of FPL for lawfully present non-citizens who are ineligible for Medicaid by reason of immigration status.
  • You are part of a tax household that will file a tax return for the coverage year and, if the tax household includes a married couple, that will file a joint return
  • You are eligible for coverage through a QHP

If you need guidance on the tax credits and subsidies SASid representatives are available to help you understand your best options.

Below is information on a subsidy estimate tool created by the Kaiser Family Foundation. It will provide you with an estimate tax credit.

The Kaiser Family Foundation health insurance cost and savings calculator

The health insurance costs and savings calculator we link to below provides only an estimate. Your final premiums and costs may differ from the estimates, perhaps significantly, depending on where you live and the coverage you select. You’ll learn your final costs for specific plans when you apply in the Health Insurance Marketplace.

Before you use the Kaiser Family Foundation calculator, there are a few important things to know:

  • The calculator provides a rough estimate of costs for insurance, based on national averages and factors that may not apply to you. It will give you an idea of what someone with circumstances like yours could pay for health insurance.
  • The calculator accounts for some factors that may determine plan costs in the Marketplace: age, family size, and tobacco use. Individual plans will weigh these factors differently to determine final prices.
  • The estimate doesn’t account for differences based on where you live, which will significantly affect Marketplace prices and offerings.
  • The prices are based on a plan in the Silver category. Plans in different categories will likely have higher or lower premiums.  (Plans found on public exchanges offer “metallic plans” with categories of Bronze, Silver, Gold, and Platinum.  These were developed and designed by the government based on essential offerings for qualification.)
  • You won’t be able to get your exact costs for a specific plan until you fill out a Marketplace application during Open Enrollment. Then you’ll see all of the plans available to you, compare features and prices side-by-side, choose a plan, and enroll. You should expect that your final cost will be different from the rough estimate provided here.

The calculator was created by the Kaiser Family Foundation, a non-profit research organization, for use by the general public. The Kaiser Family Foundation is solely responsible for the tool. The Kaiser Family Foundation has no connection with Kaiser Permanente or any health care provider.

SASid did not participate in the creation of this calculator. SASid does not warrant or guarantee the accuracy of estimates provided by the calculator.

If you’re ready to see the estimates, visit the Kaiser Family Foundation website and use the Kaiser Family Foundation’s health insurance costs and savings calculator.