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Obamacare subsidy calculator *

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For most taxpayers, your MAGI is close to AGI (Line 7 of your Form 1040 in 2018, and Line 8b in 2019).

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* This tool provides ACA premium subsidy estimates based on your household income.

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2021 Obamacare subsidy calculator

Most exchange enrollees are eligible for premium subsidies, and the American Rescue Plan makes these subsidies larger and more widely available for 2021 and 2022

Key takeaways

If you’re worried about the cost of health insurance premiums in the exchanges, it might help to know that – thanks to the Affordable Care Act’s generous subsidies, which have been temporarily enhanced under the American Rescue Plan — your premiums could end up a lot lower than you expect.

White House

An executive order signed by President Biden has authorized a COVID-related special enrollment period on HealthCare.gov. The SEP will run from February 15 to August 15.

Who’s eligible? Of the nearly 10.7 million people who had effectuated coverage through the exchanges as of 2020, 86 percent were receiving premium subsidies. Enrollment has increased in 2021, and more people are eligible for subsidies now that the American Rescue Plan has temporarily eliminated the “subsidy cliff.”

Yet about two-thirds of uninsured Americans haven’t checked recently to see if they’re eligible for financial assistance with their health insurance costs. A few more quick facts about Obamacare subsidies:

  • The subsidies are tax credits, which means you can opt to pay full price for your coverage (purchased through the exchange in your state) each month, and then get your tax credit when you file your tax return. But unlike other tax credits, the subsidies can be taken throughout the year, paid directly to your health insurer to offset the cost of your coverage.
  • Premium subsidies are normally available if your projected household income (an ACA-specific calculation) doesn’t exceed 400% of the prior year’s poverty level. But for 2021 and 2022, this limit does not apply. Before the American Rescue Plan was enacted, a single individual in the continental U.S. was ineligible for subsidies in 2021 if their income exceeded $51,040; for a family of four, the income limit was $104,800. But the American Rescue Plan changed the rules for 2021 and 2022. Instead of an income cap, the new rules allow for premium subsidies if the cost of the benchmark plan would otherwise exceed 8.5% of their ACA-specific modified adjusted gross income.
  • On the lower end, subsidies are available in most states if your income is at least 139% of the poverty level, with Medicaid available below that. But in the states that haven’t yet expanded Medicaid, premium subsidies are available if your income is at least equal to the poverty level. Unfortunately, Medicaid isn’t available below that level in those states, unless the applicant is eligible based on strict pre-ACA eligibility guidelines (ie, the states that have rejected Medicaid expansion have created a coverage gap). The American Rescue Plan does allow for $0-premium Silver plans if a person is receiving unemployment compensation in 2021, assuming the person is not otherwise eligible for Medicaid, premium-free Medicare Part A, or an employer-sponsored plan that’s considered affordable. This provision does apply to people who would otherwise be in the coverage gap, so it will help some people obtain health coverage in 2021 when they would otherwise be in the coverage gap.
  • Here’s where you can learn exactly how the subsidy amounts are determined. But you can also just use the subsidy calculator at the top of this page (note that as of early April, it has data for the 36 states that use HealthCare.gov; if you’re in a state that runs its own exchange, you can determine how much your subsidy will be using the math outlined here). The additional premium subsidies became available on HealthCare.gov as of April 1 2021, and the state-run exchanges are also working to get the new subsidy amounts displayed as quickly as possible. Subsidy eligibility determinations are fairly simple: In a nutshell, you look at your income as a percentage of the poverty level, and then find where that puts you in the sliding scale of the percentage of income you’re expected to pay for the benchmark Silver plan (it’ll be somewhere between 0% and 8.5%, depending on your income). Then you see how much more than that the benchmark plan actually costs, and the difference is the amount of your subsidy — which can be applied to any metal-level plan in the marketplace.
  • Premium subsidies aren’t available to people who are impacted by the family glitch.
  • Premium subsidy amounts fluctuate from one year to another, based on changes in the cost of the benchmark plan in each area. Premium subsidies continue to be much higher in most of the country than they were in 2017, due to the way the cost of cost-sharing reductions (CSR) has been added to silver plan premiums in most states. But for 2019, 2020, and again for 2021, premiums have decreased in some areas and new insurers have entered some markets with lower prices, resulting in smaller benchmark premiums. When benchmark premiums decrease, either due to the introduction of new plans or a reduction in prices for existing plans, premium subsidy amounts will decline. But if the benchmark premium increases, premium subsidies will also increase. And for 2021 and 2022, premium subsidy amounts are now much larger than they would otherwise be, thanks to the American Rescue Plan.
  • The subsidies cover the majority of the premiums for people who are subsidy-eligible. 86% of the people who were enrolled in exchange plans nationwide as of early 2020 were receiving premium subsidies. And the subsidies covered an average of 85% of their premium costs. The average subsidy amount in 2020 was $492/month, which covered the large majority of the average $576/month premium (note that both of these amounts are lower than they were in 2019). Again, subsidies have increased for 2021 (and will remain larger in 2022) due to the American Rescue Plan. For some people who were previously ineligible for subsidies due to the “subsidy cliff,” the new subsidies could amount to thousands of dollars a month. For others, the increase will be much smaller but still amount to significant savings.
  • Premium subsidies don’t apply to supplemental coverage, including accident supplements, adult dental/visions plans (or pediatric dental/vision plans that are sold separately from metal coverage, as opposed to being embedded in the medical plan), critical illness plans, or stand-alone prescription drug insurance (but there are free prescription drug discount plans available). Subsidies also cannot be used to purchase short-term health insurance.
  • Subsidies can lower your premium significantly, but the ACA also provides subsidies that can reduce your out-of-pocket costs when you need to use your coverage. And even though the Trump administration stopped reimbursing insurers for the cost of those cost-sharing subsidies, the benefits are still available to eligible enrollees (50% of the people with coverage through the exchanges nationwide were receiving cost-sharing subsidies in 2020, and this is likely to increase in 2021 and 2022, thanks to the American Rescue Plan’s provision that makes Silver plans more affordable for lower-income applicants).

It pays to calculate your subsidy!

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Zelmira Caceres
Zelmira Caceres
1 month ago

I am a retiree and I was surprised when I filed my 2020 income tax that I had to pay back the allowance for medical insurance from ACA/OSCAR. I had to pay over $2,000 dollars in addition to co-payments, medications, etc. What can I do to avoid paying back for subsidy allowance next year.

Louise Norris
Editor
1 month ago

For the 2020 plan year, the American Rescue Plan (which appears likely to be enacted this week) would eliminate excess subsidy repayments. See Section 9662: https://www.congress.gov/bill/117th-congress/house-bill/1319/text#toc-H43439D12D8DE48B4A7B8D83031FDFC2E
For 2021, your best bet is to notify the marketplace anytime you have a change in income, so that they can adjust your premium subsidy amount in real-time. This will prevent surprises when you file your tax return next year.

Gary Phan
Gary Phan
1 month ago

Do anyone know what’s the average Obamacare premium for a single person not including government subsidy?

Louise Norris
Editor
1 month ago
Reply to  Gary Phan

We don’t yet have exact numbers for 2021. But in 2020, it was about $575/month: https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Effectuated-Enrollment-First-Half-2020.pdf (the average subsidy, received by 86% of marketplace enrollees, was about $491/month)

Randy
Randy
27 days ago

For the subsidy, would they use your 2018 or 2019 AGI to calculate? Looks above as though they would use both?
If so, is that an average of the two years. Not explained well.

Louise Norris
Editor
27 days ago
Reply to  Randy

The American Rescue Plan has enhanced the premium tax credits for 2021 and 2022: https://www.healthinsurance.org/blog/how-the-american-rescue-plan-act-would-boost-marketplace-premium-subsidies/

But as far as income goes, premium tax credits for a given year are always based on THAT year’s income relative to the PRIOR year’s poverty level.

So for 2021 coverage, you’ll need to project your total 2021 income, and then it will be compared with the 2020 poverty level numbers to see what percentage of poverty it is. The premium subsidy amount is calculated based on that number as well as the cost of the benchmark plan: https://www.healthinsurance.org/faqs/is-the-irs-saying-ill-have-to-pay-more-for-my-health-insurance-next-year/

This can get complicated, because it’s not always easy to accurately project your income in advance. So if your income changes mid-year, it’s important to notify the marketplace (exchange) so that they can adjust your premium subsidy in realtime. It also gets reconciled with the IRS when you file your tax return. By then the year has ended, so your income is known rather than estimated.

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