Paying for Coverage

Many questions that families and individuals have about the health care law may involve costs. As you plan for enrollment, use the following information to better understand how the health care law will work with your pocketbook.

The natural question when shopping for anything is, “How much will this cost?” For the most accurate pricing information, visit the Health Insurance Marketplace to check prices and compare plans.

When using the Marketplace, you may qualify for financial assistance like:

  • Lowering your monthly payments through a tax credit
  • Getting help with out-of-pocket costs
  • Getting coverage for low or no cost to you through a government program

When you fill out your application on the Marketplace, you’ll find out what kind of assistance you qualify for.

Lowering your premiums through a tax credit

The Affordable Care Act may provide financial assistance through a tax credit. This credit helps qualified individuals and families afford health coverage bought through the Marketplace. This is how it works:

  • When you apply for health coverage on the Marketplace, information you provide on your application about how much money you make, your family size and the type of plan you purchase may qualify you for a tax credit to lower your monthly insurance premiums.
  • When you are comparing plans, the Marketplace website will show you the amount of the tax credit and your discounted monthly premium amount for each plan.
  • This credit can be applied directly to your monthly premium, so you get the lower cost immediately.

Changes to your family size, income or employment during the year can change the amount of your tax credit or make you eligible for savings if you previously had not been eligible.. You will need to report any changes through the Marketplace website. You can learn if you may be eligible for this tax credit. Click here to use the subsidy calculator.

Qualifying for help with out-of-pocket costs

If you buy coverage on the Marketplace, you may also be able to get lower out-of-pocket costs like your deductibles, copays and coinsurance. This will help with costs you have to pay when you get medical care, such as when visiting a doctor or having a medical procedure. When you apply for coverage on the Marketplace, you’ll find out if you qualify for reduced out-of-pocket costs. The amount of cost-sharing assistance you qualify for will depend on how much money you make, your family size and the type of plan you purchase. Only health insurance plans at the “Silver” plan level bought on the Marketplace qualify for assistance lowering your out-of-pocket costs.

Getting coverage for low or no cost to you through a government program

When applying for health coverage on the Marketplace, it may be determined that you or a family member qualifies for a government program at low or no cost, such as Medicaid or the Children’s Health Insurance Program (CHIP).

When you finish your application on the Marketplace and it looks like you or a family member is eligible for Medicaid or CHIP, you may automatically be enrolled. If you choose to purchase a health insurance plan on the Marketplace rather than enroll in one of these lower cost government programs, you will not be eligible for the tax credit or reduced out-of-pocket costs.

You may already qualify for Medicaid or CHIP now.