“Hey, Doc” Explains Health Insurance Subsidies

Jan. 21, 2013

The subsidies provided by the federal government to help people pay for health insurance on the Affordable Care Act's health insurance marketplace come in two different forms: a tax credit and a break on out-of-pocket costs. This week's installment of Texas Medical Association's (TMA's) "Hey, Doc" weekly education campaign explains how and when these subsidies can be used.

TMA's 16th week of "Hey, Doc" education programming

When can I receive the subsidies to help pay for my marketplace insurance?

Remember that there are two kinds of subsidies you can get to help pay for your marketplace insurance, if you qualify (see "Who gets a subsidy?"). One is a tax credit that you can put toward your monthly premiums. The other is a break on the out-of-pocket of costs you are responsible for when you use your insurance.

When it comes to the tax credit, you have three choices: You can use the full credit right away to lower the cost of your monthly premiums for the year. You can choose to put part of the tax credit toward your premiums, and if there's anything left over, you'll get the difference back after you file your taxes. Or you can wait to get the entire tax credit refunded to you after you file your taxes. In the first two options, the federal government will take your tax credit and make the payment directly to the health plan for you.

The other subsidy helps lower your out-of-pocket costs, like deductibles, co-insurance, and co-pays. But it's a little tricky. Remember the medals? The bronze, silver, gold, and platinum plans? In the bronze and silver plans, your monthly premiums are lower, but your out-of-pocket costs are higher. In gold and platinum plans, the opposite happens: They have higher premiums and lower out-of-pocket costs. This subsidy helps you get the out-of-pocket savings of a gold or platinum plan for the price of a silver one. So you would have to enroll in a silver plan to get the subsidy.

Stay tuned for more updates to TMA's "Hey, Doc" educational series in the coming weeks and months.

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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