If you buy health insurance on your own — through HealthCare.gov or your state's marketplace — you may qualify for help paying for it. Many people who could qualify never check. Here is how the main forms of financial help work.
Premium tax credits
A premium tax credit lowers your monthly premium for a plan bought through the marketplace. Whether you qualify, and how much you get, depends mainly on:
- your estimated household income for the year you want coverage,
- the number of people in your household, and
- the cost of plans where you live.
In general, you may not qualify if you can get affordable health coverage through a job, or if you qualify for Medicare or Medicaid. The income limits and amounts are set by federal law and can change from year to year, so check the current rules on HealthCare.gov or your state marketplace rather than relying on last year's numbers.
Take it now or at tax time
You can have the credit paid directly to your insurer each month, which lowers your bill right away, or claim it when you file your taxes. If you take it in advance, the amount is based on your income estimate and is reconciled on your tax return. If your actual income ends up higher than you estimated, you may have to pay some of it back — so report changes in income or household size to the marketplace during the year.
Extra savings on Silver plans
If your income is on the lower side, you may also qualify for cost-sharing reductions. These lower your deductible, copays and out-of-pocket maximum — but only if you choose a Silver plan. A Silver plan with these reductions can cost less overall than a Bronze plan for someone who expects to use care.
When you can sign up
Most people enroll during the annual Open Enrollment period, usually in late fall. Outside that window, you can enroll after a qualifying life event, such as losing other coverage, moving, getting married or having a baby — this is called a Special Enrollment Period.
Check before you assume
The quickest way to know is to enter your expected income and household details on your marketplace's estimator. Then compare plans side by side — including the premium after any credit, the deductible and whether your doctors are in network.
This guide is general information, not tax advice. Your marketplace or a tax professional can confirm your eligibility.
This guide is general information, not legal, tax or financial advice. Coverage options, discounts and eligibility vary by carrier and by state.
