WRITTEN BY: Craig Sturgill
UPDATED: SEPTEMBER 21, 2023 | 2 MIN READ
In the dynamic healthcare landscape, understanding your eligibility for Affordable Care Act (ACA) assistance is crucial. 2023 brings new opportunities for securing affordable coverage tailored to your income. This comprehensive guide breaks down the ACA income limits, assistance types, and how to make the most of your options.
Navigating ACA assistance: What you need to know
As the ACA enters its tenth year, navigating the world of healthcare assistance has never been more essential. Whether you’re an individual or a family of four, your income is pivotal in determining the support you can access.
ACA income limits for assistance
Your annual income must fall within specific brackets to qualify for ACA assistance. For 2023, individuals earning between $13,590 and $54,360 or families of four earning between $27,750 and $111,000, are eligible to explore these vital benefits.
Types of assistance available
The ACA offers three main types of assistance, each tailored to meet different needs:
- Premium tax credits: These credits help you pay your insurance premium if you buy coverage through your state’s online marketplace. Your income level determines the amount of credit you can receive, making coverage more affordable.
- Cost-sharing reduction subsidies (Silver Plans): If you opt for a Silver plan through your state’s online Marketplace, these subsidies can help lower out-of-pocket expenses, including deductibles and copays.
- Medicaid expansion and CHIP: Depending on your state’s decision, you might be eligible for Medicaid health coverage or the Children’s Health Insurance Program (CHIP) if your income falls within the eligible range.
Enrollment periods for ACA subsidies
You can enroll in a health insurance plan with ACA subsidies annually during the open enrollment period. But if you experience a qualifying life event, you might be eligible for a special enrollment period, granting you the chance to secure coverage at other times during the year.
Qualifying life events include circ*mstances such as:
- Loss of existing health coverage
- Household changes (like getting married or having a child)
- Changes in your residence (moving to a different area)
What is the cost of health insurance after ACA subsidies?
For those eligible for subsidies, the average monthly cost of health insurance in the United States is reduced to $77 after applying the subsidies.
Yet, the rates differ depending on income, and the expense of coverage can even reach as low as $0 per month. These affordable rates will remain in effect until 2025, thanks to recent legislative changes.
| State | Ave monthly premium after subsidy |
|---|---|
| US Average | $77 |
| Alabama | $66 |
| Alaska | $77 |
| Arizona | $120 |
| Arkansas | $97 |
| California | $115 |
| Colorado | $124 |
| Connecticut | $115 |
| Delaware | $114 |
| Florida | $60 |
| Georgia | $72 |
| Hawaii | $97 |
| Idaho | $63 |
| Illinois | $155 |
| Indiana | $121 |
| Iowa | $90 |
| Kansas | $104 |
| Kentucky | $113 |
| Louisiana | $118 |
| Maine | $102 |
| Maryland | $99 |
| Massachusetts | $97 |
| Michigan | $125 |
| Minnesota | $190 |
| Mississippi | $53 |
| Missouri | $93 |
| Montana | $91 |
| Nebraska | $97 |
| Nevada | N/A |
| New Hampshire | $135 |
| New Jersey | $148 |
| New Mexico | $156 |
| New York | $233 |
| North Carolina | $68 |
| North Dakota | $69 |
| Ohio | $138 |
| Oklahoma | $69 |
| Oregon | $130 |
| Pennsylvania | $133 |
| Rhode Island | $89 |
| South Carolina | $81 |
| South Dakota | $67 |
| Tennessee | $85 |
| Texas | $60 |
| Utah | $42 |
| Vermont | $135 |
| Virginia | $81 |
| Washinton | $120 |
| West Virginia | $156 |
| Wisconsin | $118 |
| Wyoming | $52 |
| Washington DC | $264 |
Understanding the eligibility chart
Understanding eligibility can be challenging, but our easy-to-follow chart breaks it down:
- If your state offers Medicaid health coverage, your income can be up to $18,754 (individual) or $38,295 (family of four).
- For premium assistance through the online marketplace, your income should be between $13,590 and $54,360 (individual) or $27,750 and $111,000 (family of four).
- Subsidies for Silver plans can be accessed with an income between $13,590 and $33,975 (individual) or $27,750 and $69,375 (family of four).
The power of federal poverty guidelines
The 2022 Federal Poverty Guidelines are pivotal in determining cost assistance under the ACA. These guidelines influence Medicaid/CHIP eligibility, Marketplace cost assistance, special enrollment, and ACA taxes for the 2023 calendar year filed in 2024.
These guidelines are structured as follows:
- One person: $13,590
- Two persons: $18,310
- Three persons: $23,030
- Four persons: $27,750
- And so on, with an additional $4,720 for each extra person in the household.
How to calculate your subsidy
Before starting your search for an ACA health insurance plan, you can gauge your potential health insurance expenses using either the subsidy calculator or performing the calculations on your own. Understanding whether you’re eligible for subsidies and having an estimate of the potential amount can guide you in selecting a plan that aligns with your needs.
The extent of your potential savings hinges on factors such as your income, family size, and the cost of a benchmark Silver plan in your area.
Subsidies are determined through two methods:
- Income-based sliding scale: If your earnings fall within 100% to 400% of the federal poverty level, you’ll qualify for a discount that adjusts according to your income level.
- Upper-income limit: If your income surpasses 400% of the federal poverty level, your health insurance expenses won’t exceed 8.5% of your household income, regardless of your total earnings.
Determining your ACA income limit and federal poverty level
First, you’ll need to calculate your income percentage compared to the federal poverty level. When considering health insurance plans for 2023, base your calculations on your projected income in 2023 and compare it to the federal poverty level figures from 2022. For instance, if you have a yearly income of $27,180, your earnings place you at 200% of the federal poverty level.
| Size of household | Federal poverty level |
|---|---|
| Family of one | $13,590 |
| Family of two | $18,310 |
| Family of three | $23,030 |
| Family of four | $27,750 |
| Family of five | $32,470 |
| Family of six | $37,190 |
| Family of seven | $41,910 |
| Family of eight | $46,630 |
Subsidy repayment and tax adjustments
You won’t be required to repay health insurance subsidies; however, there might be an adjustment during tax season. This adjustment occurs when your annual income determines whether the subsidies you received were too much or too little.
Individuals receive premium subsidies as advance tax credits, directly reducing their monthly insurance expenses. Since these credits are calculated based on your projected annual income, the actual eligible subsidy amount might vary once your precise income for the year is known.
Suppose you’re eligible for more subsidies than you initially received. In that case, any extra amount will be provided to you as a tax credit during the income tax filing process. If you received higher subsidies than you were ultimately eligible for. In that case, there’s a possibility that you’ll need to reimburse part or all of the excess amount during your tax filing.
Subsidy repayment limits (2022 tax year)
| Range of income | Repayment limit |
|---|---|
| < 200% of federal poverty level | $650 ($325 per person) |
| < 200% of the federal poverty level | $1,650 ($825 per person) |
| 300% to 399% of the federal poverty level | $2,800 ($1,400 per person) |
| > 400% of the federal poverty level | N/A |
How much will you pay for insurance based on your income?
Under the ACA, your earnings determine the ratio of your income allocated to premiums. Families with higher incomes contribute a larger share of their insurance expenses. In comparison, lower-income individuals could be eligible for fully covered health insurance, as the subsidy covers the entire plan cost.
The following chart illustrates the percentage of your income designated for insurance payments, as outlined in recent federal legislation, and this calculation will remain effective until 2025.
| % of the FPL | Minimum % paid for insurance | Maximum % paid for insurance |
|---|---|---|
| 100%-150% | 0% | 0% |
| 150%-200% | 0% | 2% |
| 200%-250% | 2% | 4% |
| 250%-300% | 4% | 6% |
| 300%-400% | 6% | 8.5% |
| 400% or higher | 8.5% | 8.5% |
Maximizing your ACA assistance: Key tips
Active Renewal: Renewing your coverage requires attention to detail. Auto-renewal may not optimize your benefits if your benchmark plan changes. To maximize your subsidy, shop yearly to secure the best plan available.
Enhanced subsidies: The Inflation Reduction Act extends enhanced subsidies that reduce costs. For instance, the subsidy fully covers the benchmark silver plan for those with income up to 150% of the federal poverty level.
New insurer entries: The market is evolving, with new insurers entering and some leaving. Knowing your options ensures you make informed decisions about your coverage.
Year-round sign-up: Low-income individuals can enroll in marketplace plans year-round. While open enrollment is recommended, the new low-income SEP (Special Enrollment Period) offers flexibility for those who miss the deadline.
A bright future for affordable coverage
As you explore ACA assistance for 2023, remember that your income opens doors to essential coverage. The Affordable Care Act’s dynamic offerings ensure you can find affordable plans that suit your needs and budget. Utilize the resources available, like the subsidy calculator, to estimate your potential benefits.
In a world of changing premiums, insurer participation, and eligibility rules, being well-informed empowers you to secure the coverage that fits your life. Take advantage of the assistance you’re eligible for and ensure a healthier and financially secure future. Your path to accessible healthcare begins with understanding the ACA income limits and making informed choices.
ACA income limit FAQs
What are the Annual Out-of-Pocket Spending Limits under the ACA?
The Affordable Care Act (ACA) establishes annual maximum out-of-pocket spending limits for cost-sharing within Marketplace plans, and Cost Sharing Reduction (CSR) plans further reduce these limits. For 2023, the maximum out-of-pocket limit is $9,100 (or $18,200 for families) across all Qualified Health Plans (QHPs). Notably, cost-sharing reduction plans can offer even lower maximum out-of-pocket amounts, ensuring enhanced affordability and financial protection for individuals and families seeking comprehensive health coverage.
What happens if I underestimate my income for Obamacare 2023?
If you underestimate, your earnings can lead to repayment discrepancies regarding subsidies. However, there’s a protective measure in place. Your repayment amount is limited if your earnings fall below 400% of the federal poverty. Crossing this threshold, though, could result in repayment of the entire subsidy sum. It’s crucial to accurately assess your earnings to avoid potential repayment issues and ensure your subsidy benefits are well-balanced.
Does ACA go by gross or net income?
Eligibility for Medicaid, premium subsidies, and cost-sharing reductions under the Affordable Care Act (ACA) hinges on your Modified Adjusted Gross Income (MAGI). However, it’s important to note that the calculation of MAGI for ACA eligibility is distinct and tailored to the ACA framework, differing from the MAGI utilized for other tax-related purposes.
Are ACA subsidies based on prior year income?
Over 85% of ACA members benefit from tax credits, which often cover about 85% of their monthly premiums, equating to roughly $500. Your health insurance subsidy hinges on your income for the present year, necessitating an estimation. It’s crucial to rely on something other than the previous year’s income for an accurate calculation.
Get help finding affordable healthcare insurance
Let us help you find the coverage that fits your needs. Use our free online rate form to review competitive health insurance in your area. We can even connect you with a licensed health insurance agent to assist with any questions.
Methodology:
AgileRates extracted and analyzed data from the following to provide data in this article.
- “Obamacare / Affordable Care Act Subsidy Calculator” (ValuePenguin)
- “Nine Changes to Watch in ACA Open Enrollment 2023” (KFF.org)
- “What Are the ACA (Obamacare) Income Limits for Subsidies in 2023?” (GoodRx)
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- ACA Open Enrollment Period 2024: Find the Best Health Insurance
- The Relationship Between State Politics and ACA Enrollment
- Making Sense of ACA Plan Options: What You Need to Know
- ACA Bronze Plans by State
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- ACA Prescription Drug Coverage: Understanding Your Options
- 2024 Open Enrollment: Finding ACA Family Health Insurance
- Transitioning from Job-Based Insurance to Private Plans
- How to Identify Your Health Insurance Coverage
- Complete Guide to Affordable Care Act Plans
