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Health Care Exchange Premium Subsidies: Do You Qualify?

October 17, 2014

By Ray Wilson+

With the new Patient Protection and Affordable Care Act, otherwise known as Health Care Exchange or ObamaCare, many people don’t know there are federal subsidies for these plans. This means that the government will pay a portion of your health insurance under the new law. There are two types of federal subsidies 1) Premium Subsidies, and 2) Cost-sharing Subsidies (coinsurance, copayments, deductibles). This page is dedicated to premium subsidies, click here if you want to learn Am I Eligible for Cost-Sharing Subsidies?

1) Do I Qualify for a Premium Subsidy?

If you make between 100-400% above the poverty line you may qualify for a receive a government subsidy (depending on age and state). This is for individuals with an annual income up to $46,680, and a household of four up to $95,400, will qualify for this benefit.

2) How Much Will My Subsidy Be?

It depends on your age, income, household, and state. In some states you may fall just under the 400% mark but if you are younger you may not actually receive subsidies. It is best to get an exchange quote and call 800-930-7956 to find out exactly what your subsidy will be.

If you already know what plan you want go to to fill out your Affordable Care Act application. Please call the number above or contact a Medicoverage Health Care Exchange agent for help with any questions you might have.

Open enrollment for new health coverage begins Nov 15, 2014. Applications must be submitted before Feb 15,2015. Apply for an ACA Plan Here


Comments for Health Care Exchange Premium Subsidies: Do You Qualify?

By Dennis Tapia on May 24, 2013

I would like more information on the Health Care Exchange Premium Subsidies.  Thank you.


We are updating this page as quickly as the information comes in from the federal government. If you want to review your particular case, please give us a call.
-Michelle from

By john on August 06, 2013

Obama care is trying to get the States to expand Medicaid. Obama care is bypassing the destitute provisions of regular Medicaid to enable non-qualifying persons to qualify. What they don’t tell you is that they will be coming for your estate after your death. Forget about leaving your house to the kids…Obama care will get it. This will help fund Obama care from the backside. This may give you something to think about before you sign up. Just be warned, it’s not what it looks like. You will find NO mention of this on the official government sites.

By arthur trantolo on August 09, 2013

two questions.

Is premium subsidy only for the silver plan? Is it available for the gold plan?

2. Can you qualify for both the premium and cost sharing subsidies?


Thank you for questions. Cost-sharing subsidies for deductibles, coinsurance, copays are only available with the Silver plan. Premium subsidies, to help with monthly costs, should be available with all plans. If you choose a Silver plan and you qualify for cost-sharing subsidies, you will also be qualified for premium subsidies. If you would like to know if you qualify for premium subsidies as well as cost-sharing subsidies please call 800-930-7956.
-Kelly from

By Chris Mihm on September 17, 2013

Here is the formula that the ACA uses for your income when determining subsides:

By sandy on September 22, 2013

Hey John are you paranoid or what? Obama care is trying to do is make all people accountable for their health care and end wastefulness. To me it seems like we are being offered the plans similar to medicare not medicaid recipients, with group buying power. I do not see them taking medicare recipients homes investments etc. People on medicare do not need to sign away their assets. I think this will be a great plan for middle income and will help make the lower income a little more accountable. Hurrah for for OBAMA GIVE IT A CHANCE GROUP BUYING POWER. NEXT HOPE TO SEE OBAMA CARE SUPPLEMENTS WITH OBAMA CARE, Sandy

By MarkEMark on September 23, 2013

Sandy.  How exactly is Obamacare offering group buying power? I’ve never heard that augment.  Arn’t we are writing our health care checks to different private insurance companies under ObamaCAre. 

What ObamaCare really is doing is changing the risk pool for insurance. It is letting people with pre-existing conditions (higher risk) to get covered AND forcing those with no insurance (historically lower risk) to have coverage. At this point I’m not sure if it will lower long run costs or not. Only time will tell.

By Sandy Shastri on September 25, 2013

I am retired.  I reside in Indiana state. Is my retired income considered for getting lower cost insurance.

Please see our article on MAGI which explains how they will calculate subsidies. The t.axable portion should be included but you may still qualify for cost-sharing subsidies to help with your out-of-pocket costs when you seek medical care and premium subsidies to help with your monthly policy cost. Call 800-930-7956 for further help.
-Chris from

By Question on September 26, 2013

Do you know if there will be an end to FSA and or HRA’s under OCare?  Will you still have an option to fund one of those plans.  Also, will employers still be taking the premiums out if we choose OCare?  If this calculation is correct, it will be significantly lower than my employer paid coverage even if I chose the Gold or above.


HSA will still be offered under the Affordable Care Act.  It is up to each individual insurance provider if they want to offer a Health Savings Account. Give us a call and we can help you location which plans are HSA compatible in your state. As far as you second question you will have to contact your employers HR team to see how they are handling employee deductions.
Chris from

By Mrs. B on September 27, 2013

I used the Kieser Foundation calculator and I’m very shocked if the result is accurate.  My husband and I, no children to insure, annual income of $68k will have a Bronze plan premium of just under $10k.  That’s $800p/mo.  How can this be possible???  I feel nausious.  I will be calling Medicoverage for more information !!  The $95. fine per person sounds like a winner for the first year to see how all of this stuff plays out.

By Veronica on October 07, 2013

If I file my taxes as married filling separately, would I only report my income not household to see if I qualify for subsidies.

Thanks for writing us.  Our understanding is that subsidy eligibility is determined by total household income and the number of people in the household. We recommend contacting a tax professional to confirm your situation. 
-Kelly from

By The Truth on October 09, 2013

Ms. B. It’s not $95 it’s 1% of your income with a minimum of $95. In your case that would be $680. So you will have to pay $680 and go without insurance. If I were you would see if there were any more options before selecting no coverage.

By Joan Hammond on October 17, 2013

If people already have Health Care Insurance Plan, do they need to get another form of coverage through the Health Care Exchange? It is my understanding hat those of us with Medicare do not need to be concerned with the Health Care Exchange. Am I wrong??

Also, aren’t people eligible for subsidies if their income is lower than the average so they don’t have to pay $2400/month for their families health care insurance? There is so much information coming across the internet, I am getting confused.


Thanks for your questions. Believe me, we know how confusing this all can be. 

1) If you are over 65 and have Medicare you don’t need to do a thing.

2) If you have a health plan that is not grandfathered (enrolled in prior to March 23, 2010), qualified job-based plan, or is not Medicare, than more than likely you’ll have to switch plans.

3)Yes, there are subsidies to lower monthly costs for people who DO NOT qualify for Medicare, Medicaid or Job-based insurance. You can learn more about obamacare subsidies here.
-Kelly from Medicoverage

By Dixie Jones on October 30, 2013

What form do the “subsidies” take? An upfront discount off the premium price, or a tax break? If the latter, how do I get the subsidy if my taxes owed is near-0?


Good question. You will get the subsidy/subsidies upfront unless you choose to wait for tax time. Most people will choose to have their subsidies right away. If you do choose to wait, we have been told that you will receive a subsidy refund, regardless if you owe $0. You will want to check with your tax professional to confirm how this will affect your taxes.
-Michelle from

By Linda on November 10, 2013

I am married and make less than 10k per year. My spouse & his children already have insurance but I do not. What are my numbers?


Good question. Because you are married, many factors are in play when deciding which plan would be available to you and at what cost.  Federal subsidies are based on the Modified Adjusted Gross Income (MAGI) of the total household. If your total household MAGI is 10k you may even qualify for Medi-caid. Please call us at 800-930-7956 so that we can help you figure out which plan works for you.
-Chris from

By Betty Simmons on December 07, 2013

Well I got my quote for Obama’s So called Healthcare and my opinion IT STINKS!!!!!! I am not able to work and just because of that I do not get help and they want me to pay $477 a month. How do they expect someone to pay that kind of premium just because they aren’t able to work and can’t get disability because they didn’t put in enough quarters to get it. Then the only income we have is my husband’s disability. It you don’t make 40,000 or more a year you are without insurance. Obama’s so called Healthcare isn’t for the people it is for the rich man.

By Singe Mom on May 29, 2014

I am a single parent and can barely afford my expenses for my family and I don’t have insurance from my children and This is NOT Affordable at all!

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