Who isn’t eligible for health insurance premium subsidies?

In order to be eligible for premium subsidies, your household income must be less than 400% of the national poverty level. However, it cannot be so low that you qualify for Medicaid, since those who qualify for Medicaid, Medicare, or a similar government program are ineligible to receive premium subsidies. If your household is just over the 400% threshold and could really use the subsidy, seek out a tax advisor and talk to them about strategies to lower your income into the acceptable range.

While income is the most talked-about qualifier for subsidies, there are other factors that can also impact one’s eligibility. For example, households who have access to comprehensive, affordable health insurance through an employer cannot receive premium subsidies, as the exchange and its subsidies are primarily meant for those who do not have access to health insurance through work.

You will also be unable to receive premium subsidies if there are plans available through the exchange in your area that are affordable even without a subsidy. Specifically, you will be unable to receive premium subsidies if the net premiums of the second-cheapest silver plan available in your area are below a certain percentage of your income. This is most commonly a problem for younger people, since they typically have very low premiums. The pricing of silver plans can vary wildly from one location to another, so whether this will be a problem for you will depend on where you live.

Last but not least, those who are not legally residing in the United States at this time or who are incarcerated are ineligible to receive premium subsidies.

Next

Do the subsidies available through the exchange count as income? If not, what are they?

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