People who don’t have medical insurance from work can buy health insurance coverage under the Affordable Care Act (ACA), also known as Obamacare. The premiums are made affordable by a premium subsidy in the form of a tax credit calculated off your income relative to the federal poverty levels (FPL), also known as HHS poverty guidelines.
You qualify for the premium subsidy only if your modified adjusted gross income (MAGI) is at 400% FPL or below. If your MAGI goes above 400% FPL even by $1, you lose all the subsidy.
Modified Adjusted Gross Income for the ACA premium subsidy is basically your adjusted gross income (AGI) plus tax-exempt muni bond interest, plus untaxed Social Security benefits. In order to see if you qualify for the premium subsidy, you have to know where the FPL is.
In addition to the maximum income to receive the premium subsidy, there’s also a minimum income to get accepted by the ACA marketplace. If your estimated income is too low, the ACA marketplace won’t accept you. They will attempt to send you to Medicaid instead. In 32 states plus Washington, DC that expanded Medicaid, the minimum income is 138% FPL. In states that didn’t expand Medicaid, the minimum income is 100% FPL and there are other qualifications in Florida that might knock you out of getting Medicaid no matter how low your income is. The Kaiser foundation has a map to show which states have adapted Medicaid expansion. To make it easy, Florida did NOT expand Medicaid and getting Medicaid is practically impossible for many people.
However, unlike the maximum income, the minimum income is only looked at the time of enrollment, not at the time when you file your tax return. If your estimated income at the time of enrollment is below the minimum, the ACA marketplace won’t accept you and they will refer you to Medicaid. If your estimated income at the time of enrollment is above the minimum and they accepted you, but due to unforeseen circumstances your income for the year ended up below the minimum, as long as you made the original estimate in good faith, you are not required to pay back the premium subsidy you already received.
Federal Poverty Level Numbers
Here are the numbers for coverage in 2019, and 2020. They increase with inflation every year in January. These are applied with a one-year lag. Your eligibility for a premium subsidy for 2019 is based on the FPL number announced in 2018. The new number announced in 2019 will be used for coverage in 2020.
To learn how to take full advantage of this chart speak to the experts at Florida Health Agency. You can reach us at (954) 332-9768 or by going to our contact page and scheduling an appointment
Newest Articles on our Blog
Paying for insurance can seem pointless since it costs so much and you still need to pay for seeing a doctor. Yet, your health insurance protects from unbelievably high costs that could easily drown you in debt. And if you ever need surgery for anything, you can go...
In need of help making sense out of Obamacare? In Deerfield Beach there are over 60 different plans available on the marketplace. It can be difficult to sort through all these plans and find the best one for your needs and your budget. At Florida Health Agency, we can...
Ever hear about supplemental health insurance? Well, what are they? Click here to learn the basics about what this actually means.
Get Your Free Copy of the “Ultimate Guide to Medicare” video and eBook from Florida Medicare Agency!
This book helps you learn about the different parts of the Medicare program, including Medicare Part A and Part B (together, they are often called “Original Medicare”), Part C (often called “Medicare Advantage”) and Part D (the part of Medicare that covers your prescription medications).
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
Florida Health Agency is a licensed health insurance agency certified to sell Medicare products.
Medicare has neither reviewed nor endorsed this information.