Am I eligible for health insurance premium tax credits (subsidies)?

shutterstock_1964163979.jpg

In 2010, the federal government passed the Affordable Care Act (ACA) to help make health care more accessible and affordable. One way the ACA does this is by offering health insurance premium tax credits (subsidies) to help individuals and families pay their monthly health insurance premiums.

So, are you eligible for a premium tax credit? Here’s what you need to know and how to see if you qualify.

What’s a health insurance premium tax credit?

Here are the health insurance premium tax credit options available from the federal government for qualifying individuals and families.

1. The advance premium tax credit lowers your monthly health insurance premium. You apply for this credit through the Health Insurance Marketplace^® at Healthcare.gov. If you qualify, you can have all or some of your credit paid in advance to help with your monthly premium. Your insurance company is notified of the credit amount and paid directly by the Marketplace; your premium is then adjusted accordingly. You can also wait to claim all or a portion of the credit on your taxes.
2. Enhanced premium tax credits are the expanded version of the advance premium tax credit. When the American Rescue Plan Act was passed in 2021, it expanded health care tax credit eligibility to include more people who buy ACA health insurance plans. It also increased the amount qualified individuals received. In 2022, the Inflation Reduction Act (IRA) extended these tax credits until the end of 2025. It's important to note these enhanced premium tax credits are set to expire.
3. Cost sharing reductions (CSR) reduce the amount you pay for deductibles, coinsurance and copays, up to your out-of-pocket maximum. You must enroll in a silver tier plan and meet other eligibility requirements to qualify for CSR.

How do I check my tax credit eligibility?

Your eligibility will depend on where you live, your family size (spouse and/or dependents) and your annual household income.

The primary factor for qualifying is income. If you make up to four times the federal poverty level, you will most likely qualify. For an individual in the continental United States, that’s about $62,600. For a family of four, that’s about $128,600. If you’re unsure about your eligibility, you can use our calculator to see if you qualify for health care savings based on your annual household income.

You will most likely be eligible for the premium tax credit if:

• You file federal income tax returns.
• You enroll in an ACA health insurance plan.
• Your annual household income is at or above 100 percent of the federal poverty level for the prior tax year.
• You are not enrolled in Medicare, Medicaid or health insurance through your employer.

What health plans are eligible for a premium tax credit?

All Wellmark individual and family ACA plans are eligible for premium tax credits. To receive a premium tax credit, your health plan must be purchased through the Health Insurance Marketplace. You can estimate your tax credit amounts and enroll in a plan directly from Wellmark.

How to apply for a health insurance premium tax credit

A local, certified Wellmark agent can help you determine if you qualify for a premium tax credit, compare plans and help you enroll. Use our Find an Agent tool to connect with a Wellmark agent near you.