Health insurance subsidies

If you don’t have health coverage through an employer and you’re not eligible for Medicare or Medicaid, you may qualify for a health care subsidy. Established by the Affordable Care Act (ACA), this federal assistance covers some of the premium and out-of-pocket costs of health coverage.

There are two types of subsidies offered:

• Advance Premium Tax Credit (APTC): With this subsidy, the federal government pays part of your monthly insurance premium. The subsidy you receive is based on the cost of health coverage in your state, your estimated income, and your household size. Household size includes you, your spouse, and any tax dependents.
• Cost-Sharing Reductions (CSRs): This subsidy reduces out-of-pocket costs by decreasing deductibles, coinsurance, copays, and out-of-pocket maximums. If you qualify for CSRs based on your income, you must enroll in a Silver plan to get these extra health insurance savings.

These subsidies are only available if you enroll in a Health Insurance Marketplace® (Marketplace) plan.

To qualify for a subsidy under health care reform, you must meet a few requirements:

• Have an income above 138% and below 400% of the Federal Poverty Level (FPL)
• Not be eligible for public coverage, such as Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, or coverage through the Armed Services
• Not have affordable access to insurance through an employer (“affordable” is defined yearly by the federal Marketplace based on the percentage of the premium an employee is responsible for)

You may be eligible for both types of subsidies. For example, if your household income is between 138% and 250% of the FPL, you could qualify for the APTC and CSRs. Use the Tax Credit Comparison Calculator to find out which subsidies you may qualify for.

Income and household information help determine your eligibility and subsidy amount. It's important to update information in your HealthCare.gov account when there are changes to your income or household size.