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What Are the Subsidies for ACA Health Insurance?

December 1, 2023

What Are the Subsidies for ACA Health Insurance?

The Affordable Care Act (ACA), commonly known as Obamacare, is comprehensive healthcare legislation that was signed into law in 2010 by President Barack Obama. The ACA was designed to provide affordable health insurance coverage to Americans while also improving access to vital healthcare services and enhancing the quality of care. The ACA has several key provisions that include things like subsidies for ACA health insurance, the expansion of Medicaid, the creation of health insurance marketplaces, and the requirement that all individuals have health insurance or face penalties. While the mandate for coverage and other aspects of the law have changed over time, more Americans have health insurance today than at any other time.


 

Historically, middle and low-income families in America have worried about finding affordable coverage for themselves and their loved ones. The cost of health insurance was a significant barrier to accessing quality healthcare. However, one of the primary goals of the ACA is to provide affordable health insurance for those who do not have coverage through their employer or other sources. Under the law, individuals and families can buy quality health insurance through the marketplace that meets their needs and budget.


 

One of the key ways that the ACA makes health insurance more accessible is through subsidies that lower the premiums and out-of-pocket costs for many health insurance plans. This means that middle- and low-income families can receive financial assistance to reduce their expenses for health care.


 

ACA subsidies were expanded with the passage of the American Recovery Plan Act (ARPA) in 2021 to provide even greater financial assistance. This expansion was later extended through 2025 with the passage of the Inflation Reduction Act (IRA). These initiatives have helped ensure more Americans have access to affordable healthcare and can receive the care they need without breaking the bank. Around 90% of those who apply for ACA health coverage receive subsidies. Let's take a closer look at the subsidies for ACA health insurance.


 

ACA Subsidies

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As discussed, one of the major aims of the ACA was to make health care more affordable for more Americans. As part of this effort, the law provides subsidies to eligible individuals and families to help them pay for their health insurance premiums and other healthcare expenses. These subsidies are available for those who purchase health insurance on the federal and state insurance marketplaces created by the ACA.


 

The ACA created the premium tax credit and cost-sharing reductions as the two types of subsidies for lowering the cost of coverage. The premium tax credit is designed to help individuals and families with lower incomes pay for health insurance premiums. This credit is based on the income level and the cost of available insurance policies. The cost-sharing reductions were created to help individuals and families with lower incomes reduce costs associated with deductibles and copayments. These reductions are dependent on income and the level of coverage chosen.


 

Premium Tax Credits

The most common subsidy offered by the ACA is advanced premium tax credits. These credits are designed to ensure people are not spending more than a certain percentage of their income on health insurance premiums. The credits are calculated based on the second-lowest-cost Silver plan available in a specific area. If a marketplace enrollee qualifies for a tax credit based on their projected income for the current year, there are two ways to take advantage of it. The premium tax credit can be paid directly to the insurance company to lower the monthly premium or claimed as a refundable credit on an individual's tax return. Once you qualify for the tax credit, you can choose how much of the subsidy you wish to use each month based on available plans.


 

Your eligibility for subsidies for ACA health insurance is based on your income in the year in which you're covered by your health plan and not on your income reported on the previous year’s tax return. You'll need to estimate your income for the upcoming year to determine your eligibility and the amount of tax credit you can receive. If your actual income turns out to be different, you might need to adjust your tax credit during the year to avoid overpayment or underpayment.


 

If you earn more than expected during the year, you may be required to pay back some or all the subsidy dollars that were applied on your behalf to your monthly health insurance premiums. If you earn less than expected during the year, you may be due additional subsidy assistance, which could be applied when you file your taxes for the year.


 

It’s important to note that tax-credit subsidies apply to ACA plans purchased through the marketplace. Tax credits do not apply to ACA-compliant plans offered outside the marketplace, catastrophic coverage plans, short-term health insurance, standalone prescription drug plans, or insurance supplements for such care as dental coverage, vision insurance, and critical illness coverage. These insurance plans could cost less, but they might provide fewer benefits than ACA plans offer.


 

Cost-Sharing Reductions

In addition to advanced premium tax credits, the ACA also provides a provision for cost-sharing reductions (CSRs). While premium tax credits help pay the cost of the health insurance itself, CSR benefits help reduce out-of-pocket expenses for Silver-level plans. If you qualify for this subsidy, health insurance providers will offer reduced copays, deductibles, coinsurance, and out-of-pocket maximums on certain healthcare services. The amount of the reduction will depend on your income level and family size.


 

These subsidies for ACA health insurance are paid directly to insurance companies, who then pass along the savings to the customer. While you could technically opt out of the CSR program, doing so would likely result in significantly higher out-of-pocket costs. However, it's important to note that the fate of CSRs has been a topic of political debate in recent years. It's possible that the program could be phased out or modified in the future, so remember to stay informed as changes occur.


 

Subsidy Qualifications

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As of 2022, there were over 14 million Americans enrolled in healthcare plans through the exchanges nationwide. The vast majority of these people were receiving premium subsidies. For these enrollees, premium subsidies cover the bulk of their premiums. These subsidies help eligible Americans pay for health insurance coverage by reducing their monthly premiums. But how do you know if you're eligible for these tax credits? In order to qualify for these subsidies, you must meet the income and other requirements.


 

Tax Credit Eligibility

Premium tax credits are granted to those with a household income between 100% and 400% of the federal poverty level. In states that have expanded Medicaid, the minimum threshold is 138% of the poverty level. The size of the tax credit you receive will depend on your income and the cost of the health plans available. The lower your income and the more expensive the plan, the larger your tax credit will be.


 

It's important to note that while there is typically an income cap of 400% of the poverty level, this doesn't apply from 2021 through 2025 due to the American Rescue Plan. Instead, eligibility for subsidies for ACA health insurance is based on the cost of the benchmark plan relative to the person’s income. If it’s more than 8.5% of your income or a lower percentage for people with lower incomes, a subsidy will generally be available.


 

In addition to income requirements, you're also required to meet other eligibility criteria. ACA premium credits aren’t available to people who are in the U.S. illegally, although they are available to immigrants living legally in the U.S. You must also not be eligible for coverage through an employer or government program such as Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). Finally, you must enroll in a health insurance plan through the federal or state-specific marketplace to receive the tax credit. By meeting these requirements, you can qualify for ACA tax credits and make health insurance coverage more affordable for you and your family.


 

Cost Sharing Eligibility

As of 2022, there were nearly 6.8 million exchange enrollees receiving CSRs. Similar to the premium tax credits, there are certain income requirements that you must meet to be eligible. CSR benefits are available to people with income between 100% and 250% of the federal poverty level. In states that have expanded Medicaid, cost-sharing subsidy eligibility starts above 138% of the poverty level. Cost-sharing subsidies are automatically incorporated into Silver-level plans when eligible enrollees shop for health insurance coverage through the marketplace exchanges. However, unlike premium tax subsidies, cost-sharing subsidies do not have to be reconciled when filing your taxes.


By meeting the eligibility requirements to receive subsidies for ACA health insurance, you can get access to government-funded assistance and gain peace of mind knowing you have affordable coverage. You can apply for ACA subsidies through the government-run health insurance marketplace in your state or through qualified licensed agents. Choosing the right insurance coverage requires a thorough understanding of your healthcare needs, financial situation, and available options. Call 1-800-314-5594 to speak to a licensed insurance agent or compare plans online!

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