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Small Business Employee Benefits and HR Blog

How To Get Help Paying for Health Insurance

Health insurance can be expensive, but if you don't have health insurance you have to pay a penalty. So, how can you or your employees get help paying for health insurance? Luckily, there are now four ways to get help paying for health insurance.help-road-sign-pixabay

4 Ways to Get Help Paying for Health Insurance 

This article takes a look at these four options for getting help with your health insurance.

  1. Federal Subsidies for Health Insurance
  2. Cost-Sharing Subsidies
  3. Medicaid
  4. Employer Reimbursement Programs

#1: Federal Subsidies for Health Insurance 

Under the Affordable Care Act (ACA), low- and middle-income Americans buying health insurance in the Marketplaces may discover they are eligible for a federal subsidy

The federal subsides (also called "premium tax credits") lower the cost of health insurance for those who are eligible. 

Am I Eligible for a Federal Subsidy?

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 to receive federal subsidies for your health insurance premium.

Individuals and families who earn up to 400% of the federal poverty line (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.

Read more here about the federal subsidies for health insurance premiums.

#2: Cost-Sharing Subsidies

Also under the Affordable Care Act, cost sharing subsidies are discounts for lower-income families to help with out-of-pocket medical expenses. 

The cost sharing subsidies are designed to help individuals and families pay for their deductible, co-insurance, and co-payments. The cost sharing subsidies are available in addition to the premium tax credits.

Am I Eligible for a Cost-Sharing Subsidy?

You are eligible for a cost-sharing subsidy if you: 

  • Have an income between 100 and 250 percent of the FPL. This is equivalent to an individual earning $29,175 in 2014, or a family of four earning $49,475 in 2014.

  • Purchased a “silver” health plan from your state’s Health Insurance Marketplace.

  • Do not have access to affordable health insurance through work or a government program.

Those who are members of a federally recognized tribe are also eligible for cost sharing subsidies.

Read more here about the cost-sharing subsidies.

#3: Medicaid

Medicaid is the nation's health insurance program for low-income individuals and families. Under the Affordable Care Act (ACA), Medicaid eligibility has expanded in many states. If your state participates in Medicaid expansion, nearly all residing adults under age 65 with family incomes up to 138% of the federal poverty level (FPL) now qualify for Medicaid.

Am I Eligible for Medicaid?

Individuals and families who earn up to 138% of FPL may be eligible. That's the equivalent to $16,105 for an individual in 2014 or $32,913 for a family of four in 2014. However, remember that each state has its own eligibility requirements, so check with your state's Health Insurance Marketplace or Medicaid office to find out if you're eligible.

#4: Ask Your Employer to Reimburse You

The last option is to ask your employer to help. Employers can set up a reimbursement program to help you with the cost of your health insurance premium. 

Am I Eligible for an Employer Reimbursement Program?

If your employer offers a reimbursement program, and you are eligible for the benefit, then this is another way to get help paying for health insurance. If your employer does not offer reimbursement for your health insurance, then ask if they will!

For more information, see this overview of individual health insurance reimbursement.

Questions about how to get help paying for health insurance? Leave a comment below.