Am I eligible for a health insurance subsidy?
Who is this for?
If you need to buy your own health insurance, this explains how to find out if you can get help paying for it.
With few exceptions, the Affordable Care Act requires everyone to have health insurance. If you're insured through your employer, or eligible for programs like Medicare or Medicaid, you're covered.
If not, you'll need to buy your own health insurance. Otherwise you'll have to pay a penalty.
Do you already pay for your own insurance? Are you shopping for the first time? Either way, the good news is you may be able to get help paying for individual health insurance. This help is called a subsidy.
What's a subsidy?
A subsidy is financial assistance that helps you pay for something. It's not a loan; you don't pay it back. There are two kinds of subsidies available from the federal government for individual health insurance plans.
- The Advanced Premium Tax Credit lowers your monthly health insurance payment, or premium.
- Cost Sharing Reduction reduces the out-of-pocket costs you pay during a policy period (usually a year) for health care services you receive. It includes your deductible, coinsurance and copays, which all add up to your out-of-pocket maximum.
When you buy your health plan, applying for a subsidy will be part of the process.
Can I get a subsidy?
It depends on:
- How your income compares to the Federal Poverty Level.
- Your family size.
- How much health insurance costs where you live.
The main factor is your income. You can qualify for a subsidy if you make up to four times the Federal Poverty Level. That's about $47,000 for an individual and $97,000 for a family of four. If you're an individual who makes about $29,000 or less, or a family of four that makes about $60,000 or less, you may qualify for both subsidies.
If you get a subsidy, you'll have to report it when you send in your taxes. When it's time to file your taxes, you'll get a 1095 form with all the necessary information.
When you're shopping for plans, you can see if you qualify for lower costs.
- How can I get advice when shopping for health insurance?
- How can I know I'm purchasing the right health insurance policy?
- What does health care reform mean for me?
- Individual and family health insurance - check out our MyBlue℠ plans designed to fit your health care needs and your budget.
- Health Insurance 101: Insurance subsidies