San Diego Financial Literacy Center

What Are the Tax Subsidies For the Affordable Care Act?

This post was originally written by TaxACT and posted on their site. You can see the original post here.

One of the central objectives of the Patient Protection and Affordable Care Act – also known as the ACA or “Obamacare” – is to make health care coverage more affordable for millions of Americans who previously couldn’t get, or couldn’t pay for, health insurance.

The ACA accomplishes this, in part, by offering tax subsidies to lower-income individuals and families. These are people who make too much money to qualify for Medicaid, but still find most health insurance plans unaffordable.

There are two distinct types of tax subsidies available for qualified Americans under the ACA:

  • Premium tax credit
  • Cost-sharing subsidies

But First, What is a Subsidy?

A healthcare subsidy lowers the amount that you spend on your monthly premium or reduces your out-of-pocket costs for things, like copays, coinsurance, and deductibles. Subsidies are “subsidized” by the federal government and are paid for through taxes.

Premium Tax Credit

The premium tax credit is a credit that lowers the monthly premium for a health insurance plan offered through the federal government’s health insurance marketplace or one of the state-run insurance exchanges. The amount of the tax credit depends on variables, like annual income and household size (how many people in the family).

In general, the premium tax credit is available for taxpayers earning between 100% and 400% of the federal poverty level for a household size.

How Do You Know If You Qualify For a Premium Tax Credit?

The best way is to apply for an insurance plan through the online marketplace. After you enter your financial and household information, the system will see how your financial situation matches up with plans available in your area.

If you qualify for the premium tax credit, you can either apply the credit in advance to lower your monthly premiums or claim it on your next tax return to receive it as a refund (or reduce the amount of taxes owed).

Keep in mind your eligibility for the premium tax credit depends on the cost of health insurance plans in your area. If premiums are relatively inexpensive where you live, you are less likely to receive a tax credit than someone earning the same amount in a more expensive health insurance market. Specifically, the marketplace uses the cost of the second-least-expensive “silver” plan to make its calculations.

Cost-Sharing Subsidies

Cost-sharing subsidies are for the lowest-income households, those earning between 100% and 250% of the federal poverty level.

While the tax credits lower the monthly premium for health insurance, cost-sharing subsidies lower the out-of-pocket costs of a health plan. These include things, like co-pays for doctor visits and deductibles.

Cost-sharing subsidies are paid directly by the government to the insurance provider, not as a tax refund.

Households can be eligible for both premium tax credits and cost-sharing subsidies.

About the Author