This tool provides a quick view of qualifications for different savings programs in your state. You’ll find out exactly what you qualify for only when you fill out a Marketplace application and get your eligibility results from the Marketplace. Please visit HealthCare.gov for more information. The subsidy amount is subject to certain limitations.
The subsidy estimate is dependent on the accuracy of the information you input and of the information and assumptions built into the calculator. The results of this calculator are not guaranteed, and at certain times may be incorrect due to outdated information or assumptions, despite our efforts to keep it accurate. You must complete the subsidy application process with the federal government to obtain a confirmed subsidy amount from the federal government.
If a person is eligible for other minimum essential coverage, that person is not eligible for this subsidy.
This application uses an estimate of the monthly premium for the Benchmark Plan, adjusted for family size, location, and age of enrollees (unless eHealth has received and the state has released the actual premium cost).
Eligibility requirements and premiums may vary by state and by the health care plan you select.
All final determinations will be made by the governing body upon enrollment.
If you qualify for a government subsidy (also called an advanced premium tax credit or APTC) to help pay your health insurance premiums on an advance basis, you can only obtain the subsidy through a government-run health exchange. Applying for a subsidy is only one potential step in getting insured. In no event will you have any coverage under a plan on a government-run health exchange unless and until the exchange has approved your application to enroll and your payment has been received.
BASIS. The Subsidy Calculator is an application intended to help you estimate your Advanced Premium Tax Credit (Subsidy) and your eligibility under the Patient Protection and Affordable Care Act, as amended (ACA).
It will also estimate the cost-sharing expense reductions (CSR) that certain individuals/families may be eligible for (if the individual/family is estimated to be eligible for the tax credit subsidy, the household income is between 100% and 250% of the Federal Poverty Level (FPL), and a Silver plan is selected).
ASSUMPTIONS. This Subsidy Calculator uses only a subset of the data inputs required by the government for the actual Subsidy determination. It does not take into consideration certain factors, including eligibility for other minimum essential coverage, tobacco usage, residency status, incarceration, etc., which may make you ineligible for the Advanced Premium Tax Credit.
The data inputted by the consumer and the FPL calculated based on such data will be used to identify the potential estimated CSR. This application utilizes the available annual Federal Poverty Levels (FPL), as provided by the U.S. Department of Health and Human Services (HHS) and published by the Federal Register. After the government releases the FPL data for each year, we appropriately update this application to use the new data as soon as we can, but at certain times this calculator may be outdated.
Taking the household size and income level that you provided, we calculate your percentage of the FPL, using the government published data mentioned above.
i. We calculate the Maximum Monthly Premium for your household (i.e., the maximum dollar amount your family should spend on health insurance premiums each month under the ACA), using the percentages in the table below. We apply the resulting percentage to your income to determine the Maximum Monthly Premium.
|
FPL percentage |
Applicable Percentage |
| At least 100% but less than 133% | 2% |
| At least 133% but less than 150% | {[(" FPL percentage" − 133) ÷ (150-133)] X (4-3)} + 3 |
| At least 150% but less than 200% | {[(" FPL percentage" − 150) ÷ (200-150)] X (6.3-4)} + 4 |
| At least 200% but less than 250% | {[(" FPL percentage" − 200) ÷ (250-200)] X (8.05-6.3)} + 6.3 |
| At least 250% but less than 300% | {[(" FPL percentage" − 250) ÷ (300-250)] X (9.5-8.05)} + 8.05 |
| At least 300% but less than 400% | 9.5% |
ii. Then, we estimate the Monthly Premium for a Benchmark Health Plan (i.e., the typical monthly cost of a health insurance premium for your family size). For the states that have already released and for which we have received the actual costs of the Benchmark Health Plan (i.e. the second lowest cost for the Silver Plan), we adjusted those numbers by the rating curve recommended by the CMS. For the states that have not yet released the Benchmark Health Plan, we are using an average cost of the states that have released the Benchmark Cost adjusted by the default federal standard age curve also recommended by the CMS or used data from a previous year. Although we try to keep this calculator updated, at certain times this calculator may return incorrect results due to outdated or inaccurate information.
iii. Finally, we subtract the Maximum Monthly Premium from the Monthly Premium for a Benchmark Health Plan to get your estimated Subsidy amount. Note that your estimated Subsidy amount will never be more than the Monthly Premium for a Benchmark Health Plan.