Q. I work part-time. Am I eligible for a premium subsidy to help me buy insurance?
A. Your eligibility for a premium subsidy isn’t tied to how many hours you work.As long as you meet the income requirements for the premium subsidies (and coverage would otherwise be considered unaffordable), are a legal U.S. resident, don’t have access to an employer’s health insurance plan that is considered affordable and provides minimum value, and you’re not eligible for Medicaid, CHIP, or premium-free Medicare, you’re eligible for a premium subsidy.
Premium subsidy eligibility extends from 100 percent to 400 percent of the poverty level. For a single person enrolling in 2021 coverage, that’s a range of $12,760 to $51,040. And for a family of four, it’s a range of $26,200 to $104,800.
But some significant caveats are needed here:
- In the majority of the country, Medicaid expansion means that Medicaid is available to adults with income up to 138 percent of the poverty level (it’s higher than this for kids, with varying limits by state). A person who is eligible for Medicaid is not eligible for premium subsidies, so subsidy eligibility for adults actually starts at 139 percent of the poverty level in most states (DC, Minnesota, and New York have higher low-end thresholds for subsidy eligibility, because of higher Medicaid limits and Basic Health Programs). And because kids are eligible for Medicaid or CHIP in households with income well above 139 percent of the poverty level, it’s common to see a household where only the adults are subsidy-eligible, with the kids covered instead by Medicaid or CHIP.
- Not everyone with incomes in the subsidy-eligible range actually receives subsidies. If the unsubsidized cost of your coverage is already considered affordable, a subsidy wouldn’t be included; this typically only applies to young applicants in areas where coverage is less expensive than average.
- Recent immigrants can qualify for subsidies with income below the poverty level, since they’re ineligible for Medicaid.
- California offers premium subsidies to people with income as high as 600 percent of the poverty level.
A more detailed explanation of subsidy eligibility determination is available here. In addition, brokers, navigators, and your state’s exchange can help you determine exactly how much your premiums will be for different plans, and whether or not you qualify for a subsidy.
You can use our subsidy calculator to get an estimate of your premium subsidy.