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Health Insurance Subsidies

Health Insurance Subsidies lower health insurance and health care costs. They are provided by the government but available with insurance plans offered in Marketplace by private companies, such as Blue Cross, Humana, or UnitedHealthCare. 

There are two types of Subsidies:

  1. Premium Tax Credit (PTC) – lowers your monthly premium, and
  2. Cost-Sharing Reduction (CSR) – lowers your out-of-pocket costs such as copayments, deductible, coinsurance. CSR is available only with Silver Plans.

Who is eligible for the Subsidies?

To be eligible for the subsidies, you have to meet the following requirements:

  1. your income must be within the range set out below,
  2. you have to be a US citizen or lawfully present immigrant, for example, Green Card, student or worker visa holder. If you are an undocumented immigrant, you may still apply for an unsubsidized health plan outside of Marketplace,
  3. you can’t have or be eligible for health coverage through a job. There are some exceptions to this rule.
  4. you can’t have or be eligible for coverage through Medicaid, Medicare, All Kids, or CHIP. If you have children covered by All Kids Insurance and you don’t qualify for it, you may still be eligible for the subsidy,
  5. if you’re married, you must file a joint income tax return (Married Filing Jointly). There are also some exceptions to this rule.
  6. you must purchase a health plan with “built-in” subsidy. 

What income qualifies for the Subsidies?

To be eligible for the subsidies your household’s income must be within the below rage. Include yourself, your spouse, if you’re married, and every person you claim as a tax dependent. In the case of self-employed individuals, net income is considered (after deducing business expenses).

 

Household Size Maximum Income for
Premium Tax Credit
Maximum Income for
Cost-Sharing Reduction
1 $49,960 $31,225
2 $67,640 $42,275
3 $85,320 $53,325
4 $103,000 $64,375
5 $120,680 $75,425
6 $138,360 $86,475
7* $156,040 $97,525

* For each person over 7 add $17,680 and $11,050. Individuals with income eligible for Medicaid don’t qualify for the subsidies.

Example: 1 person with an annual income of $35,000 will qualify only for Premium Tax Credit. A family of 4 with a yearly income of $40,000 will get both subsidies.

 

Your Subsidy

You can check here if you qualify for PTC and CSR subsidy.