Can I Get a Subsidy for My Marketplace Insurance?

Nov. 18, 2013

Once people learn how much their health insurance purchased on the Affordable Care Act's (ACA's) insurance marketplace will cost, the next natural question might be whether they qualify for assistance, or a subsidy. And if so, how much?

This installment of the Texas Medical Association's (TMA's) "Hey, Doc" weekly education campaign answers that question and more.

TMA's tenth week of "Hey, Doc" education programming

What are the subsidies?

The subsidies are provided by the federal government to help you pay for your insurance in 2014. They are available only when you buy insurance in the marketplace, and they mostly apply to people with lower incomes.

This help comes in two ways: One is a tax credit that you can use right away to reduce your monthly premiums. The other is a break on the portion of costs you are responsible for when you use your insurance. The tax credit applies to any plan you might buy, but the out-of-pocket savings apply only if you buy a silver plan.

Who gets a subsidy?

The subsidies mostly apply to people with low or middle incomes. Whether you qualify depends on how much money you make, how many people are in your family, and whether you can get coverage through your employer. In general, if you can get insurance through your work, you are probably not eligible for a subsidy. But if your income is below a certain amount, and you can't afford the insurance through your work, you might be able to get a subsidy to help pay for your insurance.

Here's a guide provided by the federal government. If this is how much you earn in a year, you might be able to get help paying for your insurance. But keep in mind this is just a guide, and it's based on 2013 numbers. So it could change in 2014. Also, if your income changes during the year, that could affect how much financial aid you get or possibly have to return to the federal government.

You might be able to get a break on the cost of your health insurance through the marketplace, if you earn this much each year:

  • $11,490 to $45,960 for individuals
  • $15,510 to $62,040 for a family of 2
  • $19,530 to $78,120 for a family of 3
  • $23,550 to $94,200 for a family of 4
  • $27,570 to $110,280 for a family of 5
  • $31,590 to $126,360 for a family of 6
  • $35,610 to $142,440 for a family of 7
  • $39,630 to $158,520 for a family of 8

If you find that you make less than the lowest number for your family size, your marketplace application will help you figure out if you can get free or low-cost insurance through a government health care program like Medicaid.

How do I apply for a subsidy?

You apply for a subsidy when you fill out an application to buy insurance in the marketplace. And you'll have to be prepared to provide some pretty specific information. You'll have to estimate how much money you and your family will make in 2014, and you'll have to include information on any family members you want to include in your insurance plan. Once you apply, the federal government will figure out first whether you qualify for a subsidy, and second, how much help you can get toward your insurance costs.

That means you'll probably have to gather up things like pay stubs and past tax returns. Healthcare.gov has a list of things you'll have to include on your application. You can also get in-person help from a marketplace navigator and community enrollment fairs throughout the state. And BeCoveredTexas.org has a hotline you can call: (866) 427-7492 (Monday through Friday, 8 am-5 pm CT).

Here are the next few TMA "Hey, Doc" reports:

Week of Dec. 2: How do I pick a physician?

Week of Dec. 9: Who will care for me? Can I keep my doctor/Why can't I keep my doctor? Can I go to my neighborhood hospital?

Week of Dec. 16: Where do I go to see the doctor?

TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 112 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

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Contact: Pam Udall
phone:(512) 370-1382
cell: (512) 413-6807

Pam Udall  

Contact: Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320

Brent Annear  

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Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy. 


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