Do I qualify for an Obamacare subsidy?
Eligibility comes down to household income, household size, and whether you have another offer of coverage. Here is how it is decided.
Most people who buy their own health insurance qualify for help paying for it. Whether you do comes down to a few specific tests.
The three tests
- Your household income relative to the federal poverty level for your household size.
- Whether you have access to other affordable coverage, such as an employer plan, Medicare or Medicaid.
- Whether you file a federal tax return, and file jointly if married, with limited exceptions.
You also have to be lawfully present in the United States and not incarcerated. See immigration status and eligibility.
Income is the main variable
The subsidy scales with income. Lower income means a larger credit. As income rises the credit shrinks.
The income figure used is a modified version of your adjusted gross income for the coverage year, and it counts everyone in your tax household, not just those on the plan.
The figure you report is an estimate of the coming year's income, not last year's. If your income changes during the year, update the Marketplace. Otherwise the difference gets reconciled at tax time, and an underestimate means paying credits back.
What counts as income
- Wages, salaries and tips
- Self employment income, net of business expenses
- Unemployment compensation
- Social Security benefits, including the portion that is not taxable
- Retirement distributions, interest, dividends and rental income
- Alimony under older agreements
Not counted: child support, most Supplemental Security Income, workers compensation, veterans disability, and gifts.
The employer coverage rule
If your employer offers coverage that meets federal affordability and minimum value standards, you generally cannot get a subsidy even if a Marketplace plan would be cheaper.
The affordability test is based on the cost of employee only coverage as a share of your household income. If your share exceeds the threshold, the offer is not considered affordable and you may qualify.
Family members have their own affordability test based on the cost of family coverage, which is a change worth knowing about if your employer's family premium is expensive.
The Texas problem
Texas did not expand Medicaid, so there is a gap. Adults whose income is below the level where Marketplace subsidies begin, and who do not qualify for Texas Medicaid, can fall between the two programs.
If a Marketplace application tells you your income is too low for a subsidy, that is what happened. It is worth a conversation rather than giving up, because how income is counted and projected can matter. See the Texas coverage gap.
How to find out
Enter your estimated household income and household size at HealthCare.gov and it will show plans with the credit applied. Nothing is committed by looking.
We cannot quote you a subsidy amount on a public page, because it depends entirely on your household details. We can run it with you at no cost. See how income limits work.
Common follow-up questions
Do I have to pay the subsidy back?
Only if your actual income ends up higher than you estimated. The difference is reconciled on your tax return, which is why updating the Marketplace when income changes matters.
Can I get a subsidy if my job offers insurance?
Usually not, unless the employer coverage fails the affordability or minimum value tests. It is worth checking rather than assuming.
What if I do not file taxes?
You generally must file to receive the credit, and file jointly if married, with limited exceptions for certain situations.
Want this looked at properly?
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