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Small Business Employee Benefits and HR Blog

FAQ - Am I Eligible for Premium Tax Credits?

Premium tax credits are available to the majority of individuals and families who do not receive insurance through work. A common question is: "Am I eligible for the premium tax credits?" This article provides an overview of premium tax credit eligibility.Premium_Tax_Credit_Eligibility

What are the Premium Tax Credits?

The premium tax credits lower the cost of health insurance for those who are eligible. The discounts are available for coverage purchased through your state's Health Insurance Marketplaces (see this Marketplace directory). The premium tax credits are also called health insurance tax subsidies.

Am I Eligible for a Premium Tax Credit?

If you meet certain income requirements, and do not have access to affordable health insurance through your employer or another government program, then you most likely qualify for a premium tax credit.

Eligibility is based on a standard called the "federal poverty level" (FPL). Your tax credit caps the cost of health insurance between 2% and 9.5% of your annual household income, depending on how much money you make relative to the FPL.

Individuals and families who earn up to 400% of FPL may be eligible. This translates to an individual earning up to $46,680 in 2014 and a family of four earning up to $95,400 in 2014.

Premium_Tax_Credit_Chart_2014

How Much are the Premium Tax Credits?

The premium tax credits cap the cost of your health insurance at 2% - 9.5% of your household income, if your household income is up to 400% above the federal poverty line (FPL).

For example, if you are single and make $25,000/year in 2014 (218% FPL), the most you will pay for a Silver health insurance plan is $258/month (6.92% of your income).

There are several online calculators available, such as this one.

How Do I Access the Premium Tax Credits?

To receive a premium tax credit, you must purchase health insurance through your state's Marketplace. 

Each state has website where you can view and compare policies, enroll in a plan, and receive the premium tax credit. A licensed health insurance broker is a great resource for help selecting a health plan. Look up your state marketplace here.

How Can My Employer Help?

Your employer can help you with the cost of your individual health insurance plan, and allow you to be eligible for the premium tax credits, by setting up a plan to reimburse you for your premium expenses.

This type of plan is called a defined contribution plan, premium reimbursement program, or a Healthcare Reimbursement Plan.

See this example of how employers can help.

Questions about eligibility for premium tax credits? Leave a comment and we'll help answer them.

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