Do I qualify for an Obamacare subsidy?

It comes down to household income, household size, and whether you can get coverage another way. Here is how the Marketplace decides.

Updated September 3, 2026 · 3 min read · by Gerino Alejos

Key points

Three things decide it: your household income, your household size, and whether you can get coverage somewhere else.
If your job offers coverage that meets the federal affordability and minimum value standards, you generally cannot get a credit.
If your income changes during the year, tell the Marketplace, or the difference gets squared up at tax time and guessing low means paying credits back.

Most people who buy their own health insurance get help paying for it. That help is a premium tax credit, money the government puts toward your premium, the monthly bill for the plan. Whether you get it comes down to a few specific tests.

The three tests

Your household income, measured against the federal poverty level, a federal income yardstick that changes with household size.
Whether you can get other affordable coverage, such as a job plan, Medicare, or Medicaid, the program for people with low income.
Whether you file a federal tax return, and file jointly if you are married. There are limited exceptions.

You also have to be lawfully present in the United States and not in jail. See immigration status and eligibility.

Income is the main variable

The credit moves with income. The lower your income, the larger the credit. As income goes up, the credit shrinks.

The Marketplace, the government site where you shop for these plans, uses a modified version of your adjusted gross income for the year you are covered. It counts everyone in your tax household, not just the people on the plan.

The income you report is an estimate of the coming year, not last year. If it changes during the year, tell the Marketplace. Otherwise the difference gets squared up on your tax return, and guessing low means paying credits back.

What counts as income

Wages, salaries and tips
Self employment income, after business expenses
Unemployment pay
Social Security benefits, including the part that is not taxed
Money you take out of retirement accounts, plus interest, dividends and rent you collect
Alimony under older agreements

Not counted: child support, most Supplemental Security Income, workers compensation, veterans disability, and gifts.

The employer coverage rule

If your job offers coverage that meets the federal affordability and minimum value standards, you generally cannot get a credit. That holds even if a Marketplace plan would cost you less.

The affordability test looks at what employee only coverage would cost you, as a share of your household income. If your share is above the line, the offer does not count as affordable, and a credit may be possible.

Family members get their own affordability test, based on what family coverage costs. That is worth knowing if the family premium at your job is expensive.

The Texas problem

Texas did not expand Medicaid, so there is a gap. Some adults earn too little for Marketplace credits and still do not qualify for Texas Medicaid. They fall between the two programs.

If your Marketplace application says your income is too low for a credit, 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

Put your estimated household income and household size into HealthCare.gov. It will show plans with the credit already applied. Looking commits you to nothing.

We cannot print a credit amount on a public page, because it turns on your own household details. We can run it with you at no cost. See how income limits work.

Pull together last year's tax return and your estimate for next year, then check the site or let us sit down with you. Call our McAllen office at (956) 687 3334, or use the ZIP form on this page.

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 squared up on your tax return. That is why telling the Marketplace about an income change matters.

Can I get a subsidy if my job offers insurance?

Usually not, unless that 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 get the credit, and file jointly if you are married. There are limited exceptions for certain situations.

Want this looked at properly?

We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.

Call (956) 687 3334

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