Who ISN’T eligible for Obamacare’s premium subsidies?

Q. Obamacare advocates frequently talk about how most exchange enrollees qualify for government subsidies. But who is left out? Aren’t there some people who really want and need the tax credits who aren’t eligible?

A. You aren’t eligible for government subsidies to help cover health insurance premiums if:

Understandably, people who earn a little more than 400 percent of the FPL are often very disappointed when they don’t qualify for a premium subsidy. And for some of them – particularly older applicants in areas where coverage is very expensive – coverage remains unaffordable. If your income is just a little over the subsidy-eligibility threshold, you can talk with a tax advisor about strategies for lowering your modified adjusted gross income to make it subsidy-eligible.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Lakshman Nandwani
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Lakshman Nandwani

I am retired and live with wife. I make less than 50k after taxes and more than 50 K before taxes.i have Medicare A&B
Will I qualify Obama or trump care act.

Louise Norris
Editor

Can you clarify what things you’re wondering about qualifying for? TrumpCare is just a term that people use to refer to various health care reform proposals that Trump has put forth, as well as things like the administration’s expansion of short-term health plans. ObamaCare refers to the Affordable Care Act (which Obama signed into law in 2010), but it didn’t make very many changes to Medicare.

Jeanette potter
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Jeanette potter

My husband & I live in NY State I am on medicare and he still works. If he is under the 400 mark can he get on the on Obama plan with me even thou I am on medicare

Louise Norris
Editor

Jeanette,
You cannot enroll in an individual market plan, since you’re on Medicare. But your husband can enroll in a plan through NY State of Health (if he’s uninsured, there’s currently an enrollment window due to the COVID-19 pandemic; otherwise he’ll need a qualifying event or would have to wait until open enrollment in the fall). His eligibility for premium subsidies will depend on your total household income, and how it compares with the full-price cost of the benchmark plan for him. Here’s an FAQ that might help to clarify how this works: https://www.healthinsurance.org/faqs/i-am-on-medicare-and-social-security-my-wife-is-self-employed-and-needs-insurance-from-the-state-exchange-how-do-we-figure-our-household-income/