Who is Eligible for Individual Health Coverage?

Q: Who is Eligible for Individual Health Coverage?

A: In order to qualify for assistance with health insurance costs, you must:

• Live in the United States
• Be a U.S. Citizen or national, or otherwise legally reside in the country
• Not be incarcerated
• Not have access to affordable health insurance coverage through an employer, Medicare or any other source

Based on the size of your household and how much you earn, you may qualify for a subsidy, also known as a tax credit. The amount of your premium tax credit is determined on a sliding scale by your earnings and the cost of coverage as a percentage of income. Specifically, the cost of coverage is based on the second cheapest silver plan on the exchange in your area. This is referred to as a benchmark plan in the ACA.

The lower your income, the higher your tax credit will be, and you may be eligible for tax credits to help pay for cost sharing if you earn up to 250% FPL. For premium tax credits, you cannot pay more than:

• 3% of income at 133% FPL
• 4% of income at 150% FPL
• 6.3% of income at 200% FPL
• 9.5% of income at 300% – 400% FPL

Tax credits can be applied to any health plan, but the value will vary based on the difference between the cost of the benchmark plan and your maximum monthly premium.

Click here to use our Subsidy Calculator