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Small Business Employee Benefits and HR Blog

FAQ: Do I Qualify to Save on Health Insurance?

November 6, 2014
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When the Health Insurance Marketplaces open on November 15th for general enrollment, anyone can purchase a personal health insurance plan. During this "annual open enrollment period," you, your employees, and your clients may be shopping for a personal health insurance plan. This article answers the frequently asked question, "Do I qualify to save on health insurance?"FAQs - Do I Qualify to Save on Health Insurance?

Do I Qualify to Save on Health Insurance?

When you apply for 2015 Marketplace coverage, you and your family members may be eligible to save on health insurance in three ways:

  1. Premium tax credits,
  2. Medicaid, or
  3. Children’s Health Insurance Program (CHIP)

Premium Tax Credits

To know if you qualify to save on health insurance through the premium tax credits, calculate your annual household income and check a chart (like the one below).

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

Eligibility for the premium tax credits 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.

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Chart Source: healthcare.gov

Medicaid and CHIP

Medicaid and CHIP are federally-run programs that offer health services to low income adults and children, respectively. The ACA gives each state the option for Medicaid Expansion, which broadens Medicaid coverage to include non-elderly citizens with incomes up to 138% of the FPL.

Many states have expanded Medicaid eligibility, and the chart above outlines incomes that are eligible. For more on Medicaid eligibility, click here.

Tip: When you apply for coverage through your state's Marketplace (ex: healthcare.gov), the application process will notify you what type of savings you qualify for.

What questions do you have about qualifying to save on health insurance? Leave a comment below, and we'll help answer it.

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