Eligibility Requirements for Subsidies

One of the most important features of coverage available on the Individual Marketplace is the availability of premium tax credits and cost sharing reductions to make the coverage more affordable for certain individuals.

If you qualify, they can be used to offset your premium cost. In some cases, your cost can be as low as $0.

Eligibility

In order to be eligible for premium tax credits you must:

  1.  Be a resident of the state in which marketplace you are applying.
  2.  Be legally present. (i.e. you do not have to be a US Citizen; however, you must be here legally).*
  3.  Not be incarcerated.
  4.  Not covered under other qualified coverage. This would include Medicare and Medicaid.
  5.  Not covered or eligible for employer sponsored coverage that meets the following requirements:
    1. The coverage has an actuarial value of at least 60% (Bronze Plan)
    2. The employee’s cost share for single coverage is not more than 9.5% of that employee’s wages. (Please note that if you are married, the entire family is disqualified if either spouse is offered qualifying coverage.)
  6. Must have household income (modified adjusted gross income) between 100% and 400% of Federal Poverty Level. (And, if Married, must file a joint tax return.)

* Non-Citizens who are legally present can qualify for premium tax credits even if their incomes fall below the Federal Poverty Level.

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