Income Levels & Savings

Determine if you qualify for savings on Marketplace premiums, or if you are eligible for Medicaid or the Children’s Health Insurance Program (CHIP), based on your income. To receive accurate plan prices and savings, complete a Marketplace application.

Steps to Check Your Eligibility:

1.Specify Household Size: Indicate the number of people in your household, including yourself, your spouse if married, and anyone you claim as a tax dependent—even if they do not require coverage.

1. • Select the number of people (1–10).

2. Estimate Household Income: Provide the estimated total income for your household this year. This estimate should reflect anticipated changes, not last year's income.

• • Select your income range.

Next Steps:

• Estimate Your Income: Start with your adjusted gross income and adjust for expected changes. Savings are based on your estimated income for the coverage year, not the previous year.

• Special Enrollment Period: You may qualify to enroll in or modify Marketplace coverage based on your estimated income. Use our income calculator for a more accurate estimate.

• Include the Right People: Include yourself, your spouse if applicable, and all individuals you claim as tax dependents, regardless of their need for coverage.

Saving on Your Monthly Premium with a Premium Tax Credit

When applying for Marketplace coverage, you might qualify for a "premium tax credit" that reduces your monthly insurance premiums. The amount of this credit is based on your estimated household income for the coverage year.

Eligibility and Application:

• Check Your Income: Confirm if your estimated income qualifies you for the premium tax credit.
• Advance Payments: You can apply the credit directly to your monthly premium. The Marketplace will send this credit to your insurance provider, reducing your monthly payment.

Adjusting for Income Changes:

• Income Increase or Household Reduction: If your income rises or you lose a household member, your credit may decrease. Adjust the advance payment to match your eligibility and avoid excess repayment at tax time.
• Income Decrease or Household Expansion: If your income falls or you gain a household member, your credit may increase. Adjust the advance payment to lower your monthly premiums.

End-of-Year Reconciliation:

• If you receive more advance payments than you qualify for, you may need to repay the difference when filing your federal tax return.

Cost-Sharing Reductions

Once you submit your application to the Marketplace, you’ll learn if you qualify for the premium tax credit, which reduces your monthly health insurance costs. Additionally, you may be eligible for "cost-sharing reductions," which lower your out-of-pocket expenses for medical services.

Eligibility for Cost-Sharing Reductions:

• Silver Plan Requirement: To benefit from cost-sharing reductions, you must select a Silver plan. While the premium tax credit can be applied to any plan, cost-sharing reductions are exclusive to Silver plans.
• Special Enrollment: If you lose cost-sharing reductions while enrolled in a Silver plan, you may qualify for a Special Enrollment Period. This allows you to switch to a plan that fits your needs and budget, including Bronze, Silver, or Gold plans.

Determining Your Eligibility:

• Income Range: Check if your estimated income qualifies for cost-sharing reductions. The lower your income within the qualifying range, the greater your potential savings.
• Exact Savings: Detailed savings amounts are provided after applying and reviewing Silver plans in the Marketplace.

How Cost-Sharing Reductions Work:

• Lower Deductibles: Your deductible will be reduced, meaning the insurance starts covering costs sooner. For example, if a Silver plan normally has a $750 deductible, qualifying for cost-sharing reductions could lower it to $300 or $500, depending on your income.
• Reduced Copayments and Coinsurance: You’ll pay less for services like doctor visits. For instance, if a typical copayment is $30, you might only pay $15 or $20 with cost-sharing reductions.
• Lower Out-of-Pocket Maximums: Your annual maximum spending limit will be lower. Instead of a $5,000 out-of-pocket maximum, it could be reduced to $3,000, depending on your income.

Additional Information:

• Variation in Costs: The exact amount you save will vary based on the Silver plan you choose and your specific circumstances.
• American Indians and Alaska Natives: Additional cost-sharing reduction benefits may be available.

For a precise calculation of your savings, apply and compare Silver plans through the Marketplace.