What is Health Insurance Subsidy?

Individual and Family Health Plans

health insurance subsidy

Subsidy Towards Health Insurance Premiums:

A subsidy is a government credit towards your premiums based on your age, household size and income. The subsidy is applied automatically to your monthly premium, making what you pay per month more affordable. Subsidies can also trigger you to be eligible for Cost Sharing Reduction, this makes deductibles and copayments for doctors lower on silver plans.

Head over to Health Insurance page, and enter your zip code to find out if you’re eligible for a subsidy.

Federal Poverty Level (FPL):

A measure of income issued every yare aby the Department of Health and Human Services (HHS). Federal poverty levels are used  to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.

Subsidy and CSR Qualification

Household Income
Househould Members
Below $17,774
Individual 🧑
Medicaid Eligible
Household Income
Househould Members
$ 17,774 - $32,200
Individual 🧑
Marketplace plan with subsidy plus CSR
Household Income
Househould Members
$32,200 - $51,520
Individual 🧑
Marketplace plan with subsidy
Household Income
Househould Members
Above $ 51,520
Individual 🧑
No Subsidy
Household Income
Household Members
Below $24,039
Family of 2 🧑🧑
Medicaid Eligibile
Household Income
Household Members
$ 24,039 - $43,550
Family of 2 🧑🧑
Marketplace plan with subsidy plus CSR (savings on dedcutibles and OOP)
Household Income
Household Members
$43,550 - $69,680
Family of 2 🧑🧑
Marketplace plan with subsidy
Household Income
Household Members
Above $ 69,680
Family of 2 🧑🧑
No Subsidy
Household Income
Household Members
Below $30,304
Family of 3 🧑🧑🧑
Medicaid Eligibile
Household Income
Household Members
$ 30,304 - $54,900
Family of 3 🧑🧑🧑
Marketplace plan with subsidy plus CSR (savings on dedcutibles and OOP)
Household Income
Household Members
$54,900 - $87,840
Family of 3 🧑🧑🧑
Marketplace plan with subsidy
Household Income
Household Members
Above $ 87,840
Family of 3 🧑🧑🧑
No Subsidy
Household Income
Household Members
Below $36,570
Family of 4 🧑🧑🧑🧑
Medicaid Eligibile
Household Income
Household Members
$ 36,570 - $66,250
Family of 4 🧑🧑🧑🧑
Marketplace plan with subsidy plus CSR (savings on dedcutibles and OOP)
Household Income
Household Members
$66,250 - $106,000
Family of 4 🧑🧑🧑🧑
Marketplace plan with subsidy
Household Income
Household Members
Above $ 106,000
Family of 4 🧑🧑🧑🧑
No Subsidy

What is Cost Sharing Reduction (CSR)?

Cost Sharing reduction is the industry term used to identify the extra financial help many people get to lower their deductibles and out of pocket costs for care and prescription drugs. You must enroll in the silver plan to get the Cost Sharing Reduction, and you only qualify if your income is under a certain amount. Check the table below to see if you qualify for Cost Sharing Reduction towards a silver plan.

How federal poverty levels are used to determine eligibility for reduced cost health coverage (CSR)?

  • Income above 400% FPL: If your income is above 400% FPL, you may now qualify for premium tax credits that lower your monthly premium for a 2021 Marketplace health insurance plan.
  • Income between 100% and 400% FPL: If your income is in this range, in all states you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan.
  • Income below 138% FPL: If your income is below 138% FPL and your state has expanded Medicaid coverage, you qualify for Medicaid based only on your income.
  • Income below 100% FPL: If your income falls below 100% FPL, you probably won’t qualify for savings on a Marketplace health insurance plan or for income-based Medicaid.

How to find an affordable health insurance plan if I’m not eligible for subsidy?

You can consider purchasing a short term health insurance plan or  fixed befit medical plan that pays per claim. These plans are cheaper than the marketplace plans. However, you need to keep in mind that indemnity plans do not follow the ACA rules and do not cover pre-existing conditions. Speak to a licensed agent to learn more.

I’m eligible for subsidy, but I do not want to use, can I still apply for a health insurance plan?

Yes. You can apply for an Off-Exchange plan and pay full premium. You do not need to use healthcare.gov to apply for an Off-Exchange plan since Healthcare.gov only offers marketplace plans that are on-exchange. Check out health insurance page to learn about different health insurance carriers. You can apply directly with the carrier. 

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