Obamacare News Blog

Health Care Exchange Premium Subsidies: Do You Qualify?

The Affordable Care Act, otherwise known as ObamaCare, offers subsidies to help 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) What is a Monthly Premium?

A monthly premium is the amount you pay your insurance company for your plan. This may also be called your monthly bill.

2) Do I Qualify for a Premium Subsidy?

If your live in one of these gold states, you may qualify for a premium subsidy to help pay your monthly bill if your income falls within the perimeters of the chart below.

Household Members Income Range
1 $16,104 - $46,680
2 $21,707 - $62,920
3 $27,310 - $79,160
4 $32,913 - $95,400
5 $38,515 - $111,640
6 $44,118 - $127,880

If you live in one of the gold states, you may receive a premium subsidy if your income falls within the perimeters of the chart below.

Household Members Income Range
1 $11,670 - $46,680
2 $15,730 - $62,920
3 $19,790 - $79,160
4 $23,850 - $95,400
5 $27,910 - $111,640
6 $31,970 - $127,880

3) How Much Will My Subsidy Be?

The amount of your premium subsidy will depend on a few factors: your age, income, household size, and state. In some states, you may fall just under the 400% mark, but if you are relatively young you may not receive subsidies. It is best to get an exchange quote or call 800-930-7956 to find out exactly how much your subsidy will be.

Article Updated 11/6/2015

If you already know what plan you want go to Healthapplication.com 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.

Comments and Questions

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Comment from FN on June 02, 2016

I am looking for coverage for my parents (mom -62 and dad-66). My father has medicare A coverage but doesn’t cover majority of services. They do not have any income and they are in NJ. Could you please recommend a plan that will work for them?


If your parents have no income they should qualify for Medicaid, which can help cover premiums and other costs. You should contact your local Medicaid office to see what their options are.

-Amy from http://www.medicoverage.com/

Comment from Linda on May 05, 2016

I might be losing my job soon and thus my medical coverage. I am 58 and my is husband is 65 and already retired. I am also covering my 23 old son who is soon to graduate from college so that might end soon. I believe that based on income we might be covered by a subsidy but I have a few questions. Can my husband somehow apply for supplemental coverage through the marketplace and should he do so separately? Also can I apply even though I still have coverage through my employer at this time or should I wait until I no longer have a job? If I do it now would I fill out the application as if I no longer had a job or is there somewhere to explain?


Since your husband is 65, he should qualify to enroll in a Medigap plan to supplement his Medicare. As for you and your son, you can apply once you receive a letter saying your job-based coverage will end. In the meantime, call one of our licensed independent insurance agents at 800-930-7956, and we can help you find the right plan for your needs.

-Amy from http://www.medicoverage.com/

Comment from CW on April 28, 2016

My husband is going to retire at age 62.  If I add him to my health insurance through work, paying a premium of $500 per month, for him alone, would we be eligible for a tax rebate on his premiums if our income is less than $50,000?


Usually, if you are offered job-based insurance you have to enroll in it, unless it is more than 9.66% of your income. This is only for the plan that offered to you, not to your spouse or dependents. If your health insurance through work is more than that, you can apply for subsidies, if it isn’t you would pay full price through the marketplace. If you need help finding a plan in your area call one of our licensed independent insurance agents at 800-930-7956.

-Eric from http://www.medicoverage.com/

Comment from Cathy on December 07, 2015

If a person qualifies for premium subsidies on the public exchanges, what kind of documentation will they receive regarding their qualification for these subsidies?  Is there a letter they get that states they qualify for a specified time period?  Who would issue this documentation?


If you qualify for subsidies, the Exchange will let you know right away They may also send you a follow up letter. The subsidies are applied for the full year, but if your income changes, you must report it immediately, because your subsidy amount could change, as well as, you could owe back all or part of your subsidies if your income increases. Hope this helps!

-Jacima from http://www.medicoverage.com/

Comment from Stan on January 18, 2015

Are there any financial circumstances whereby a person could obtain a premium plan that requires no monthly charge?


There are some income levels that you could pay $0 to a few dollars a month for an on Exchange plan. To have a qualifying income level would depend on your state, age, and zip code. If you’re curious about your specific subsidy call 800-930-7956.
-Chris www.medicoverage.com

Comment from Jaxn on November 20, 2014

Obamacare is a fraud. My household consists of 3 people. Our total monthly income is 2375 per month. The cheapest plan we can get is 675 per month. That is 28.42% of my total living income. It is absurd to think that people can afford this. That equates to 566 dollars per month per person in my home to live on. Electricity, Heating, Food, Car Payment, House Payment, car insurance, home insurance, etc. And this is supposed to be “AFFORDABLE”!?!?!? B*#L&h*t


We totally understand your frustration. Just know that there are premium subsidies and cost-sharing subsidies that you may qualify for. This could significantly lower your premium and out of pocket costs. As well as if the lowest cost qualifying plan exceeds 8% of your income you may be exempt from Obamacare penalties if you didn’t enroll. Please call us so that we can help you find a more affordable plan for you and your family. Our number is 800-930-7956.
-Chris http://www.medicoverage.com

Comment from sue caropepe on October 30, 2014

my son and i are both disabed . he presently has coverage with gov’t subsidy and i have none.  what will qualify for a subsidy?  he is paraplegic and i have scleroderma,raynauds and anxiety disorder.  we both recieve ssd benefits. (I shouldrecieve my first benefit payment tomorrow.  canyou fill me in with any quotes? he is 40, i am 58. 


Thank you for your questions. Due to the specificity of your questions we suggest you give us a call at 800-930-7956 so that we can figure out if you qualify for subsidies.
-Eric from www.senior65.com

Comment from 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!

Comment from 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.

Comment from 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 www.medicoverage.com

Comment from 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 www.Medicoverage.com

Comment from 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

Comment from 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.

Comment from 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 Medicoverage.com

Comment from 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.

Comment from 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 Medicoverage.com

Comment from 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. http://www.medicoverage.com/health-insurance-blog/news/magi-and-the-affordable-care-act 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 Medicoverage.com

Comment from 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.

Comment from 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

Comment from Chris Mihm on September 17, 2013

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


Comment from 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 www.medicoverage.com

Comment from 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.

Comment from 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 Medicoverage.com

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