Cost Sharing Reduction Subsidies – to lower out of pocket costs
Medicaid and CHIP
Some additional FAQ’s
Cost assistance subsidies are made available only in your states health insurance marketplace. Many health insurance brokers can help you outside the marketplace can help you enroll in a marketplace plan. Medicaid and CHIP are the exceptions since they may be obtained any time in the year and Medicare then has its own open enrollment period.
Subsidies are based on your income. For most states, anyone can get on Market plans some type of subsidy if making less than 400% of the FPL (Federal Poverty Level)
Each year the Federal Poverty Level will adjust for inflation, this allows an increased number of Americans who can then qualify for cost assistance.
There are less tax credits for people making below 400% of the FPL, cost sharing reductions are available for people making less than 250% of FPL on silver plans. Ins states that expanded Medicare and make less than 138% are eligible for Medicaid.
To determine subsidies is household income modified adjusted gross income or the MAGI; this figure is after most of the deductions have been taken out.
Qualifying for cost assistance, then a marketplace plan cannot exceed the cost over 9.5% of your current income. That is after any tax credits have been applied. So the lower the cap when you make less.
The amount of cost assistance available is based on your states Marketplace second lowest cost Silver plans.
For states that did not expand Medicaid many won’t qualify because they have fallen into the Medicaid gap, not qualifying for Medicaid or subsidies when making less than 100% FPL.
Silver Plans are the only plans where cost sharing reductions subsidies are made available.
To lower premiums tax credits may be applied in advance in part or in full or may be adjusted on federal income taxes.