Health Insurance Subsidy Eligibility Requirements

The Health Care Reform brought about two types of subsidies to health insurance coverage. In order to qualify for them, you must meet all the requirements listed below.

Premium Subsidy (aka Advanced Premium Tax Credit)

  • you must be a US citizen or a legal immigrant (green card or other valid visa such as a student or work visa). If you don’t meet this requirement, you may still purchase a health insurance policy,
  • you must purchase one of the four new health insurance plans: Platinum, Gold, Silver, or Bronze, with “built in” subsidy,
  • you can’t have coverage under Medicaid, Medicare, All Kids, CHIP or be eligible for any of the programs. If your children have All Kids Insurance and you don’t qualify for it, you may still be eligible for the subsidy,
  • your income cannot exceed the amounts listed below,
  • you can’t have or be eligible for employer-sponsored coverage. There are exceptions to this rule.
  • if you're married, you must file a joint income tax return (Married Filing Jointly). There are also exceptions to this rule.

Cost-Sharing Reduction

  • in order to get this subsidy you must meet all requirements for Premium Subsidy,
  • your income cannot exceed the amounts listed below,
  • you must purchase a Silver Plan, with “built in” subsidy,

Maximum Income for
Premium Subsidy
Maximum Income for
Cost-Sharing Subsidy
1 $48,560 $30,350
2 $65,840 $41,150
3 $83,120 $51,950
4 $100,400 $62,750
5 $117,680 $73,550
6 $134,960 $84,350
7 i wiecej* $17,280 $10,800

*Last updated: 10/22/2018. To each additional person, please add the indicated amount. Individuals eligible for Medicaid don't qualify for the subsidies.

You may also want to read this: How the premium and cost sharing subsidies work?

Health Insurance

Government Health Insurance Subsidies

In order to help cover the high costs of health insurance, Obamacare introduced subsidized insurance. Read more.

New Metal
Health Plans

In order to facilitate comparison of health insurance plans, the Reform introduced new health plans: Platinum, Gold, Silver, Bronze, and Catastrophic. Read more.