Financial Assistance for Healthcare

Subsidies for Individuals / Family Insurance

Many individuals and families purchasing health insurance can benefit from health insurance subsidies, including premium tax credits and cost-sharing reductions, to help cover premiums and out-of-pocket costs. 

Premium Tax Credits

These premium tax credits effectively reduce your monthly health plan payments. They are available to individuals and families with incomes ranging from 100% to 400% of the federal poverty level. You can apply this credit towards any metal level plan, whether platinum, gold, silver, or bronze.

Cost-Sharing Reductions (CSRs)

Cost-sharing reductions help to lower your out-of-pocket expenses associated with health insurance. These programs provide discounts that decrease costs before your insurance starts paying, including reductions in deductibles, copays, and coinsurance. To qualify for these cost-sharing reductions, you must select a silver metal level plan.

How It Works

To determine your premium tax credit, you will need to complete an application on your state's Health Insurance Marketplace. The Marketplace will consider three key pieces of information from your application:

- Your household size

- Your estimated household income

- The average price of plans in your area (benchmark plan)

With this information, your state’s Marketplace will calculate your premium tax credit using the formula: Benchmark Plan Cost - Premium Contribution = Your Premium Tax Credit.

Why It Changes Each Year

Each year, your state’s Health Insurance Marketplace selects a new benchmark plan, which is always the second-lowest cost silver plan available in your area. This means that both your monthly premium and premium tax credit may vary yearly based on any adjustments to your income and household size.

How to Access Your Tax Credit

If you qualify for a tax credit, you have the option to receive it in two ways:

1. Apply it to your monthly premium: You can use your tax credit to reduce your monthly payments. The Marketplace will send this amount directly to your insurance company, leaving you responsible for the remaining balance.

2. Claim it when filing your tax return: Alternatively, you can choose to claim your tax credit when filing your tax return. If you’ve used part of the credit for your monthly payments, you can claim the remainder at that time.

It's important to note that if you receive more in advance than you qualify for, you'll need to repay the excess when you file your taxes. Conversely, if you received less, you will be entitled to a refund for the difference.

Do You Qualify?

Here are some general guidelines for determining eligibility for health insurance subsidies:

- Individuals: Income below $51,520

- Couples: Household income below $69,680

- Four-person families: Household income below $106,000