Google+
BlueCross BlueShield of North Carolina

Tax Credits and Cost-Sharing Reductions

To help make health care more affordable, the federal government offers advance premium tax credits, or subsidies, to low-to middle-income individuals and families. Your subsidy is an advance premium tax credit and is applied directly to your premium. Subsidies reduce the monthly cost of an insurance plan. You do not have to pay the cost upfront and receive your tax credit later.

To be eligible for a subsidy, you must meet certain requirements.1

  • Be between 100% and 400% of the federal poverty level (FPL).
  • Not eligible for public coverage, such as Medicaid, the Children's Health Insurance Program, Medicare or military coverage.
  • Not have access to insurance through an employer. An exception can be made if the employer's plan doesn't cover at least an average of 60% of covered benefits or if the employee's share of the premium is more than 9.5% of his or her income. Employers can tell you if their plans meet these criteria.

Subsidies can be used on any plan you choose except for grandfathered plans and catastrophic plans for those under 30. How much of a subsidy you qualify for is based on income and household size.

Our Free Rate Quote offers a calculator to determine if a subsidy may be available to you.

2013 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA2

Persons in family/household

100% Poverty guideline

250% Poverty guideline

400% Poverty guideline

1

$11,490

$28,735

$45,960

2

$15,510

$38,775

$62,040

3

$19,530

$48,825

$78,120

4

$23,550

$58,875

$94,200

5

$27,570

$68,925

$110,280

6

$31,590

$78,975

$126,360

7

$35,610

$89,025

$142,440

8

$39,630

$99,075

$158,520

For each additional person, add:

$4,020

$10,050

$16,080

In addition to advance premium tax credits, the government also provides cost-sharing reductions (CSR) for those who qualify. CSR allows you to pay for a standard silver plan, but get richer benefits.

To be eligible for CSR, your income must be between 100% and 250% of the federal poverty level (FPL).

CSR is only available on silver plans. These special CSR plans provide enhanced benefits that can mean your "silver" plan has the benefits of a plan with a higher metallic value.

Percent of FPL

Income for a family of 4 based on the 2013 FPL1

Your "silver" plan has benefits like:

200% - 250%

$47,100 - $58,875

An upgraded silver plan

150% - 200%

$53,325 - $47,100

A gold plan

100% - 150%

$23,550 - $35,325

A platinum plan

With the enhanced benefits, you can save money on your out-of-pocket costs. For example, when visiting the doctor you could have a $5 copayment instead of a $25 copayment. You could also have an out-of-pocket limit of $2,000 instead of $6,350.3

The enhanced benefits do not cost you any more than you would pay for an ordinary silver plan. In addition, you can still use any subsidy you qualify for to lower your monthly premiums.

If you qualify for CSR, you'll see these plans marked as Silver Enhanced when you get a free rate quote.

2013 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA2

Persons in family/household

100% Poverty guideline

250% Poverty guideline

400% Poverty guideline

1

$11,490

$28,735

$45,960

2

$15,510

$38,775

$62,040

3

$19,530

$48,825

$78,120

4

$23,550

$58,875

$94,200

5

$27,570

$68,925

$110,280

6

$31,590

$78,975

$126,360

7

$35,610

$89,025

$142,440

8

$39,630

$99,075

$158,520

For each additional person, add:

$4,020

$10,050

$16,080

How much of an advance premium tax credit (subsidy) or cost-sharing reduction you qualify for depends on your total household income and number of people in your household.4

For example:

  • A family of 4 with total household income of $29,438 per year would be eligible for a subsidy of approximately $796 per month. That's 94% off our second lowest silver plan.

    This family would also be eligible for benefit upgrades under cost-sharing reductions. Instead of $6,350 out-of-pocket (OOP) limit, they would have a $700 OOP limit. So expenses are capped at $700 no matter what and BCBSNC will fully cover every covered benefit expense after that. Plus, they would get $5 primary care office visit copayments and $10 specialist office visit copayments. Normally they would pay $25 for a primary care visit and $50 for a specialist.

  • A family of 4 with a total household income of $52,988 per year would be eligible for a subsidy of approximately $528 per month, or 63% off our second lowest silver plan.

    They are also eligible for upgraded benefits. Instead of a $6,350 OOP limit, they would have a $5,000 OOP limit. So expenses are capped at $5,000 no matter what and BCBSNC will pay all covered expenses after that.

  • A family of 4 with a total household income of $88,313 per year would be eligible for a subsidy of approximately $146 per month. That's a 17% discount on our second lowest silver plan.
  • A family of 4 with a total household income of $100,088 per year would not be eligible for a subsidy.

Figures are for illustrative purposes only and based on current data. This information is subject to change, and final subsidy and cost sharing determinations will be made by the federal government. Your coverage and premiums depend on your actual subsidy and cost-sharing reduction and the type of plan you choose.

Getting your subsidy starts with a free rate quote. In your rate quote, we'll show you your estimated subsidy and how it affects your premium.

  • To get the actual amount of your subsidy, you'll need to go to the federal Health Insurance Marketplace. BCBSNC makes it easy by transferring you directly to the Marketplace.
  • Once at the Marketplace, you'll need your Social Security number, employer and income information to register and complete your subsidy application.
  • Then you'll be automatically transferred back to BCBSNC to see your final subsidy and premium.
  • Choose and buy your plan.

Attention: This website is operated by Blue Cross and Blue Shield of North Carolina and is not the Health Insurance Marketplace website. This website does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.

  1. All requirements for subsidy eligibility are determined by the federal government. Please go to the Health Insurance Marketplace for more information.
  2. Office of the Assistant Secretary for Planning and Evaluation. US Department of Health and Human Services. "2013 Poverty Guidelines." http://aspe.hhs.gov/poverty/13poverty.cfm#guidelines. Accessed May 6, 2013.
  3. Figures are for illustrative purposes only and are not a guarantee of benefit levels. Your actual benefits will depend o n the type of plan you choose.
  4. Internal data. Estimated data as of 5/21/13 for a family of 4 (ages 40, 40, 8, 12) in Durham county. Percent discount is based off an estimate of the second lowest silver plan for this family of four.

U9625, 10/13