Can I get subsidies for insurance?

Find options to help with insurance costs

Everyone should have access to health insurance. If you’re struggling to make ends meet, there are options to help you get the care you need when you need it. Many programs were created for the purpose of helping individuals who have limited or moderate income and resources.

What is the ACA?

The Affordable Care Act (ACA) was designed to help individuals and their dependents get health insurance coverage when they might not otherwise have been able to afford it. ACA subsidies can be a lifeline to those who qualify, going toward paying health insurance premiums and out-of-pocket costs.

People who qualify:

  • Have a household income that falls within a certain range
  • Don’t have access to affordable coverage through their employer
  • Are not eligible for coverage through Children's Health Insurance Program (CHIP), TRICARE, Medicaid or Medicare1

What are health insurance subsidies?

The two types of subsidies are premium tax credits and cost-sharing reductions.

What’s a premium tax credit? How does it work?

Premium tax credits are offered through the Health Insurance Marketplace. They are in place to:

  • Reduce monthly payments, or premiums, paid to your insurance plan
  • Cap the amount an individual or family must pay for health insurance

The size of the premium tax credit is based on a sliding scale. That means people who have a lower income will get a larger credit. That’s to help cover the cost of their insurance.2 The credit is sent directly to your insurance company.

What is cost sharing?

Cost sharing is literally “sharing” medical costs with your insurance company. You pay some costs out of pocket. Your insurance company also pays some costs. You are cost-sharing when you pay these types of costs:

Let’s look at two examples of $0 cost-sharing

  1. You pay $0 for preventive care because your insurance plan covers it at 100%
  2. You pay the full amount if a certain service isn’t covered or if you choose an out-of-network provider

Cost-sharing only applies when you pay part and your insurance company pays part. Sometimes your insurance company pays everything — and on the flip side, sometimes you might be responsible for the full amount.

What are cost-sharing reductions?

Cost-sharing reductions (also called decreased cost-sharing or “extra savings”) are part of the Affordable Care Act. It’s there to help people save on out-of-pocket costs. People who qualify for cost-sharing reductions may have a lower out-of-pocket maximum. They may also have lower copays and deductibles.3 Cost-sharing reductions are in place to help people get the care they need.

What is Medicare?

Medicare is the federal health insurance program for those who are:4

  • Age 65 or older
  • Younger than 65 with a qualifying disability (and on Social Security disability for at least two years)
  • Any age with a diagnosis of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s disease)
  • Receiving Railroad Retirement benefits

What is Medicaid?

Medicaid is a federal-state public health insurance program providing coverage to low-income children, adults and people with disabilities.5 Medicaid is managed at the state level (and the rules vary from state to state).

What is Children's Health Insurance Program (CHIP)?

Another national health insurance program is the Children’s Health Insurance Program (CHIP). It covers uninsured children from low-income families who are not eligible for Medicaid.

What are Dual Special Needs Plans (D-SNP)?

Special Needs Plans (SNP) are a special category within Medicare Advantage. These plans combine the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D) — all in one plan.

One type of SNP is a Dual Eligible Special Needs Plan. It’s often referred to as “D-SNP” plan. It provides health benefits to people who qualify for both Medicaid and Medicare. Whether you have a chronic heart condition, diabetes, dementia or another condition, with a D-SNP, your benefits are customized to meet your specific needs. That means you may have access to special programs, specialists and care coordinators. The goal is to help you stay as healthy as possible.

What is COBRA?

If you lose your job or your hours are reduced, you might worry that you’ll lose your health insurance. In order to help people in those unexpected situations, the Consolidated Omnibus Budget Reconciliation Act (COBRA) law was enacted as a short-term insurance solution.6

You can elect COBRA if you lost coverage because:

  • Your work hours were reduced
  • You quit or lost your job (unless it was “gross misconduct”)
  • You are transitioning between jobs
  • The covered employee/policyholder dies
  • You are going through a divorce
  • You turn 26 and no longer covered under your parents’ insurance
  • You become eligible for Medicare

COBRA can help you stay covered when you might not have health insurance otherwise. Typically, you can only keep COBRA coverage for up to 18 months, so it’s a good idea to explore other long-term options.