Are You Eligible for Help with Your Health Insurance Costs?

The health care law helps many people pay for health insurance. Based on your income, family size and the health plan you choose, you may qualify for tax credits and help paying for coverage.

There are two ways eligible people may get help paying for coverage – tax credits and cost-sharing assistance. These funds are available when you enroll in coverage on the Health Insurance Marketplace. The Marketplace provides a way for you to compare and buy a health insurance plan that best fits your needs. You can enroll for health insurance during open enrollment.

Tax Credits

These credits will help eligible people pay for insurance premiums – the monthly cost of coverage. They are available to people who purchase coverage on their own (not with an employer) through the Marketplace. The credit is designed so even those who have little or no income or do not file an income tax return can still benefit. If you qualify, the credit can be paid in advance to your insurance company.

Cost-Sharing Assistance

Most health insurance plans have out-of-pocket costs that you pay at the time you receive medical treatment. You may pay part of the cost for a doctor visit, medical procedure or test. Cost-sharing assistance helps lower these out-of-pocket costs. The Marketplace can help you determine whether you may qualify for cost-sharing assistance.

How Much Cost Assistance Should You Expect?

Financial assistance is determined by your household income, family size, and the health plan you choose. If you meet income requirements, your health plan will pay a greater amount of covered costs, reducing how much you pay. For example, you may pick a plan for which you pay from 10 to 40% of covered costs. The amount is also based in part on any medical procedure or tests you have – each may have a deductible or coinsurance cost.

Penalties for Not Getting Health Insurance

As of today, ACA still requires most Americans to purchase health coverage or pay a penalty.* Failing to obtain insurance may result in a tax penalty on your annual income tax return.

In 2017, the tax penalty will increase annually by a cost-of-living adjustment or 2.5% of the total household taxable income (whichever is greater).

*A few groups/individuals are exempt: certain religious groups, American Indians and people who are incarcerated or in financial hardship.

You may compare and buy a health plan on the Marketplace during open enrollment.

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