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
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?
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
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
- $19,790 to $79,160 for a family of three
- $23,850 to $95,400 for a family of
- $27,910 to $111,640 for a family of
- $31,970 to $127,880 for a family of six
- $36,030 to $144,120 for a family of
- $40,090 to $160,360 for a family of
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
- $19,790 to $49,475 for a family of
- $23,850 to $59,625 for a family of
- $27,910 to $69,775 for a family of
- $31,970 to $79,925 for a family of
- $36,030 to $90,075 for a family of
- $40,090 to $100,225 for a family of
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
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.
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.
phone: (512) 370-1381
cell: (512) 656-7320
phone: (512) 370-1382
cell: (512) 650-5336
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Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.