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Frequently Asked Questions

How do Copays, Deductibles & Coinsurance Work
Penalties of Individual Mandate
What is Health Insurance
Doctors, Hospitals & Facilities

Subsidies/Calculator (government assistance)

Subsidies: Who is eligible and how do they work?

Starting January 1, 2014, individuals may be able to get subsidies or tax credits when they buy health coverage.

Subsidies for individuals

Starting January 1, 2014, individuals may be able to get subsidies or tax credits when they buy health coverage.

  • In 2014, people who qualify may be able to get a Subsidy from the government to help you buy health coverage and pay part of your premiums. You don’t have to wait until tax time to get it as it will be deducted from the cost of your individual plan sold on the exchange.

Who qualifies for the subsidy?

  • People who are U.S. citizens or legally live in the U.S.
  • People earning between 100% and 400% of the federal poverty level if they are not eligible for other sources of minimum essential coverage, including government-sponsored programs such as Medicare and Medicaid or SCHIP.

Who qualifies for additional Coinsurance Assistance?

  • People with incomes up to 250% of the federal poverty level may also qualify for lower cost shares for services covered by the Silver plan. The federal government subsidizes the higher benefits provided by the insurer. This will be managed by the insurance carrier on your health plan.

Who doesn’t qualify?

  • People who qualify for Medicare or Medicaid or SCHIP.
  • People who are offered a qualified plan at work with premiums that cost less than 9.5% of their earnings.

When does open enrollment start?

Open enrollment for plans offered through the health insurance marketplace is November 15, 2014 through February 15, 2015. Coverage effective dates will vary for those that enroll after January 1, 2014.

Do cost estimation calculators provide definitive estimates of what people will pay under the health reform law?

No. The calculator is intended to illustrate how families in varying circumstances may be affected by the tax credits and limits on age rating included in the law. There are many other factors that could increase or decrease how much people pay, including changes in family size, adjustment in earnings and tobacco use.

How do premium subsidies work?

People purchasing coverage on their own will be eligible for government subsidies (through a tax credit) toward their health insurance premiums based on income. Subsidies will be provided to people with family income between 100% and 400% of the federal poverty level. The federal poverty level varies by family size. In 2013, it is $11,490 for a single adult and $23,550 for a family of 4. The poverty level is estimated for 2014 based on Congressional Budget Office projections of inflation. The most that these families buying subsidized coverage in an exchange will pay toward a health insurance premium will range from 2.0% of income at 100% of poverty to 9.5% of income at 400% of poverty, with amounts at specific income levels specified in a table in the law. Subsidies are only available to those purchasing coverage through the exchanges. When an exchange determines that a person is eligible for a tax credit based on expected income, and that person enrolls in coverage, subsidies will be paid directly to insurers to lower the cost of premiums (and in some cases cost sharing).

What is included in household income? How do I know what to enter?

The calculator allows users to enter household income in terms of 2014 dollars or as a percent of the federal poverty level. Household income includes incomes of the taxpayer, spouse, and dependents. In determining eligibility for subsidies, exchanges will calculate enrollees’ household incomes using Modified Adjusted Gross Income. This includes all income sources such as wages, salary, interest, dividends, and Social Security. Modified Adjusted Gross Income does not include income from gifts, inheritance, and Survivors Benefits, and some other income sources are partially excluded.