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Financial Help for Health Insurance See if you can get financial help with the costs of your health insurance.

Did You Know?

Financial help is only available for health insurance plans bought through the Health Insurance Marketplace.

Financial Help Defined

Financial help is in the form of a tax credit from the Federal government to help pay for the costs of health insurance you bought through the Health Insurance Marketplace.

Frequently Asked Questions

Can I get financial help with the costs of my health insurance?

Some low- and moderate-income families can qualify for financial help to pay for their monthly payments (premiums) for a health plan bought through the Health Insurance Marketplace (but not for plans bought on your own, outside the marketplace). That help is provided through a premium tax credit, which will lower the amount of the premium you must pay. You can use the premium tax credit in a few ways. You can use some or all of it right away as a discount on your premium, so you owe less when you make your monthly payment. You also can choose to get a partial or full refund when you file your taxes the following year. The premium tax credits are based on a sliding scale, so that the greatest help is available to people with the lowest income.
Find out what coverage, costs, and comparisons to consider when shopping for health insurance.

If your income changes in the middle of the year—whether your income goes up or down—be sure to let the Health Insurance Marketplace know, in case your premium tax credit must be adjusted. If your income goes up and you don’t notify the Health Insurance Marketplace, you may owe more in taxes for that year.

If I have health coverage through my job, can I get financial help with the costs of my health coverage?

Most people who have health coverage through their employer are not eligible for premium tax credits in the Health Insurance Marketplace. In certain circumstances, you may be able to get a premium tax credit if your employer coverage is neither “affordable” nor “adequate,” as defined by the law, and you meet specific limited income levels. For example, for coverage in 2018, an individual with a household income between about $12,060 and $48,240 or a family of four with a household income between about $24,600 and $98,400 may be eligible for premium tax credits for coverage in the Health Insurance Marketplace. These are ballpark figures and will change each year. Check with your human resources department to learn more about your employer’s health plan or with your Health Insurance Marketplace to see if you quality for financial help. You can also use this Health Insurance Marketplace Calculator to get an estimate of the financial help you may qualify for if you buy coverage through the Health Insurance Marketplace.

I have retiree coverage from my former employer but it’s expensive. I’m not eligible for Medicare yet; will I be able to buy coverage in the Health Insurance Marketplace until then?

If you have retiree health coverage, it is important to know that you are not eligible for financial help through the Health Insurance Marketplace. If you are considering dropping your retiree coverage, you can shop for a new plan through the Health Insurance Marketplace and you may be able to get financial help based on your household size and income. However, you won’t be able to enroll until the next marketplace open enrollment period. You also may not be able to return to the retiree plan if you drop it. Be sure to compare costs and benefits and talk with your former employer about your coverage options before you make any changes.

Once you become eligible for Medicare, you will not use the Health Insurance Marketplace and won’t be eligible for financial help through the marketplace.

Glossary

  • Coinsurance

    your share of the costs of a covered health care service, calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the plan’s allowed amount for an office visit is $100, and you’ve met your deductible, your coinsurance payment of 20 percent would be $20. The health plan pays the rest of the allowed amount.

  • Premium tax credits

    an amount that can be subtracted from the amount of income tax a person or business owes. Premium tax credits will be offered to some individuals and small businesses that purchase health coverage through the Health Insurance Marketplace, to help pay for the cost of coverage. You can have the tax credit applied to your premium over the course of the year, or wait until you file your taxes to claim the full amount.

  • Deductible

    the amount you owe for health care services your health plan covers before your health plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

  • Copayment

    a fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

  • Out-of-pocket costs

    health care or prescription drug costs that you must pay yourself because they are not covered by Medicare or other insurance. Out-of-pocket costs include deductibles, coinsurance and copayments for covered services. They also include costs for services that are not covered by a health plan.

  • Cost-sharing subsidy

    under the health care law, low- and moderate-income families may be eligible for financial help to pay for some of their health care costs. Cost-sharing subsidies will help lower the deductible, copayments and coinsurance for people who qualify for this help.

  • Federal poverty level (FPL)

    a measure of income level issued annually by the U.S. Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits.

Read More Glossary Terms

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