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ACA Subsidy Check In!
Here at Ford Insurance Group, we are aware of the need for affordable healthcare, our goal is to bring to the marketplace the best available health insurance including, the Affordable Care Act (ACA) plans nationwide. Our agents are certified ACA "Obama Care" brokers who can assist in helping you find the best solution and subsidy available.
The Affordable Care Act is the 2010 comprehensive health law known as “Obamacare” or, simply, the ACA. Health insurance through an Affordable Care Act marketplace plan can help to protect you from financial pain if you have an injury or illness.
ACA plans are also a safety-net option for people who do not have access to job-based insurance or government insurance such as Medicaid and Medicare.
The ACA may allow you to receive a premium tax credit, or premium subsidy, based on your household’s size and income. This will help you save on the monthly cost of your health insurance plan.
Keep reading to find out whether you could qualify for an ACA plan subsidy.
What are the Affordable Care Act’s income limits for financial help?
The Affordable Care Act offers new financial help that will make health plans more accessible than ever in the 2023 coverage year. The Centers for Medicare & Medicaid Services (CMS) reports that 4 out of 5 people will be able to find a plan for $10 or less per month.
What you pay and how much you save depends on your household income. You qualify for a subsidy based on how your household income compares to the federal poverty level (FPL). The ACA uses your modified adjusted gross income (MAGI) to determine savings. This is different from your adjusted gross income, which appears on your tax return. MAGI is not a number on your tax return. Additionally, your savings will be calculated from an estimated household income for the year that you want health insurance coverage.
Generally, if your household income is 100% to 400% of the federal poverty level, you will qualify for a premium subsidy. This means an eligible single person can earn from $13,590 to $54,360 in 2022 and qualify for the tax credit. (Federal poverty levels for 2023 were not available at publication time, but the federal government’s link will be updated.)
A family of three would qualify with income from $23,030 to $92,120 in 2022. The range would be $27,750 to $111,000 in 2022 for a family of four. (Income limits may be higher in Alaska and Hawaii because the federal poverty level is higher in those states.) The American Rescue Plan Act of 2021 also extended subsidy eligibility to some people earning more than 400% of the federal poverty level.
Heathcare.gov offers a calculator to help you determine whether you would qualify for savings. The site also explains what kinds of income to include in your estimate. If your income is below 138% of the federal poverty level, and you live in a state with expanded Medicaid coverage, you may qualify for Medicaid, based solely on your income. The Affordable Care Act enrollment process will help you sign up for Medicaid in your state.
If your income is below 100% of the federal poverty level, you are probably not eligible for savings on an ACA plan or for Medicaid solely based on income.
What does the Affordable Care Act cover?
The Affordable Care Act aims to make healthcare coverage more accessible in several ways:
- Households with incomes from 100% to 400% of the federal poverty level receive subsidies that reduce their health insurance costs.
- States have the option of expanding Medicaid to cover people with household incomes below 138% of the federal poverty level, or $38,295 for a family of four in 2022.
- Consumers receive preventive-care services without out-of-pocket costs.
- Consumers who have pre-existing health conditions can receive coverage.
- Young adults can remain on their parents' health insurance plans until age 26.
ACA health insurance plans also cover these 10 essential health benefits:
- Emergency services
- Hospitalization
- Laboratory services
- Mental health and substance use disorder services
- Outpatient care
- Pediatric services, including oral and vision care for children
- Pregnancy, maternity, and newborn care
- Prescription drugs
- Preventive and wellness services
- Rehabilitative services
How does my income affect what I pay for coverage?
The ACA provides savings for low-income and moderate-income individuals and families. Generally, the less money you make, the more financial help you will receive under the law.
Families earning 100% to 400% of the federal poverty level — and sometimes more — will qualify for savings on monthly premiums. What you pay each month also depends on the plan you select.
ACA plans are organized by metal tiers: bronze, silver, gold, and platinum. Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs when you receive care. Platinum plans have the highest monthly costs but the lowest expenses when you access care.
More generous subsidies now fully cover the cost of a benchmark silver plan for consumers with incomes up to 150% of the federal poverty level in 2022. This same group also receives extra savings (which are only available when enrolled in a silver plan) that greatly reduce deductibles and copays to costs similar to platinum plans.
Subsidies are based on your estimated income in a coverage year, but your actual income could be higher or lower. If your earnings are less or more, your premium tax credit could be adjusted. For example, if you earn more than you estimated, you may have a higher tax bill because you received too much in subsidies. To avoid this, make sure you report income changes throughout the year.
How does the ACA make individual health insurance more affordable?
The ACA makes health insurance more affordable by:
- Placing certain limits on what insurance providers can charge consumers. Insurers are prohibited from charging consumers higher premiums because they have a pre-existing condition such as cancer or diabetes.
- Providing subsidies to low-income and moderate-income people to reduce their overall health insurance costs.
- Ensuring that consumers covered by ACA health plans receive certain preventive health services — including wellness visits, mammograms, and other screenings, as well as some vaccinations — without out-of-pocket costs.
- Offering additional cost-sharing reductions for people who qualify and choose a silver plan. These are “extra savings” on out-of-pocket expenses such as your deductible, copayment, and coinsurance.
- Allowing states to expand their Medicaid programs to provide coverage to people with slightly higher incomes than previously qualified.
How do I enroll in the ACA?
There are several ways to sign up:
- Enroll online through Healthcare.gov.
- Use the Find Local Help tool to locate in-person assistance in your area with a navigator as well as with an agent or broker. All of them are trained to walk you through the marketplace process, and services are free.
- Apply through the website of a certified enrollment partner, such as a private health insurance company.
- Enroll by phone by contacting the Marketplace Call Center at 800-318-2596. This line is available 24 hours a day, 7 days a week — excluding holidays — with service in English and other languages.
- Complete and mail an application.
The bottom line
The Affordable Care Act offers health insurance options for people who don’t have access to job-based insurance and may not qualify for Medicaid. The ACA now offers most enrollees premium subsidies that reduce monthly healthcare costs. Initially, your premium tax credit will be based on your estimated income for the coverage year. Your actual income may be more or less than expected. If your income exceeds your estimate, this may result in a higher tax bill.
References
Healthcare.gov. (n.d.). Adjusted gross income (AGI).
Healthcare.gov. (n.d.). Affordable Care Act (ACA).
View All References (21)
ACA aka Obama Care!
To check to see if you are eligible for a subsidy, click the "Find Out More" button below. Give us a call and we'll help guide you through the process.
There is never a fee for broker assistance with the ACA. Our brokers are paid by the carriers we represent and it does not affect your coverage pricing.
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