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 2020, and 2021. They increase with inflation every year in January. These are applied with a one-year lag. Your eligibility for a premium subsidy for 2020 is based on the FPL number announced in 2019. The new number announced in 2020 will be used for coverage in 2021.
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
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.