Hey, Doc, Can Health Insurance Subsidies Help Me?

Dec. 02, 2014

This week’s segment in Texas Medical Association’s (TMA’s) “Hey, Doc” health insurance marketplace education campaign answers questions about the tough part — paying for insurance — and how to get assistance. The aid is called a subsidy, as TMA’s “Hey, Doc” physician expert Carlos J. Cardenas, MD, explains in this video.

Hey, Doc, What are the subsidies?

The subsidies are provided by the federal government to help you pay for your insurance. 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?

Subsidies are provided by the federal government to help you pay for your insurance. 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 are the latest guides provided by the federal government. If this is how much you make in a year, you might be able to get help paying for your insurance. But keep in mind this is just a guide and could change each year. Also, if your income changes during the year, that could affect how much 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 monthly health insurance premiums through the marketplace, if you make this much each year:

  • $11,670 to $46,680 for individuals 
  • $15,730 to $62,920 for a family of two 
  • $19,790 to $79,160 for a family of three 
  • $23,850 to $95,400 for a family of four 
  • $27,910 to $111,640 for a family of five 
  • $31,970 to $127,880 for a family of six 
  • $36,030 to $144,120 for a family of seven 
  • $40,090 to $160,360 for a family of eight 

You might be able to get a break on your out-of-pocket costs when you use the insurance you buy through the marketplace, if you make this much each year:

  • $11,670 to $29,175 for individuals 
  • $15,730 to $39,325 for a family of two 
  • $19,790 to $49,475 for a family of three 
  • $23,850 to $59,625 for a family of four 
  • $27,910 to $69,775 for a family of five 
  • $31,970 to $79,925 for a family of six 
  • $36,030 to $90,075 for a family of seven 
  • $40,090 to $100,225 for a family of eight 

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 during the year, 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 (M-F, 8 am-5 pm CT).

You can find each week’s “Hey, Doc” Q&A and a lot more at texmed.org/Heydoc as well as in TMA’s patient blog at MeAndMyDoctor.com. And TMA produced “Hey, Doc” videos to help people understand how to navigate the marketplace.

Below is TMA’s “Hey, Doc” content schedule through the next several weeks.

Dec. 10: How do I renew my marketplace plan? Will I still get my subsidy from last year?

Dec. 17: When does my coverage start? What will it cost me to buy this insurance? What different kinds of insurance can I buy?

Dec. 22: What is catastrophic insurance? What is covered by this insurance?

TMA is the largest state medical society in the nation, representing more than 48,000 physician and medical student members. It is located in Austin and has 110 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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Contacts: 

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

Marcus Cooper
phone: (512) 370-1382
cell: (512) 650-5336 
Marcus Cooper 

Click here to follow TMA on Twitter. Or visit TMA on Facebook. 

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

Last Updated On

March 14, 2018