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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.

healthinsurance.org does not collect or store any personal information from individuals using our subsidy calculator.

2022 Obamacare subsidy calculator

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

Key takeaways

If you’re worried about the cost of health insurance premiums in the exchange/marketplace, 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.

Open enrollment for 2022 coverage ended on January 15 in nearly every state. However, many individuals will be able to enroll after January 15 if they have a qualifying life event that triggers a special enrollment period.

Who’s eligible? Of the 11.3 million people who had effectuated coverage through the exchanges as of early 2021, 86% were receiving premium subsidies. Enrollment has increased since then, 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 aren’t aware of the financial assistance that’s available for health insurance coverage. The American Rescue Plan was enacted mid-year in 2021, so for people who haven’t checked their subsidy eligibility since the fall of 2020, the outlook is likely to be much better for 2022, with larger and more widely available subsidies.

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 above 138% 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; this is the case in 11 states as of late 2021). 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 have been in the coverage gap. The Build Back Better Act called for this provision to exist in 2022 as well, but the future of that legislation is up in the air, as the version that passed the House has failed to gain enough support in the Senate.
  • 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 (if subsidy data are not available for your state, you can determine how much your subsidy will be using the math outlined here). 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, and due to the American Rescue Plan. But for 2019, 2020, 2021, and again for 2022, 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 again, 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 2021 were receiving premium subsidies. And the subsidies covered an average of 85% of their premium costs. This was before the American Rescue Plan was implemented; since then, even more people qualify for subsidies and the subsidies cover an even larger percentage of their costs. 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, as long as you enroll in a Silver plan. 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. Forty-eight percent of the people with coverage through the exchanges nationwide were receiving cost-sharing subsidies in early 2021; this increased later in the year, as the American Rescue Plan’s enhanced subsidies made it easier for lower-income Americans to afford Silver plans.

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Zelmira Caceres
Zelmira Caceres
1 year 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 year 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 year ago

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

Louise Norris
Editor
1 year 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
1 year 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
1 year 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.

Peter Bourey
Peter Bourey
9 months ago

This process is a whole lot more complicated, it would seem, than it should be. It is nearly impossible to get clear numbers about income levels versus subsidies. I am a family of two and can’t find even approximate numbers about what the subsidy would be if I made more money due to RMDs.

Louise Norris
Editor
9 months ago
Reply to  Peter Bourey

Peter, have you tried inputting the new income amounts into the calculator above? It has an income slider so that you can adjust your income and see how it adjusts your subsidy amounts. Assuming everything else is staying the same (household size and zip code), the subsidy amount will adjust based on the income changes you make.

Penny
Penny
6 months ago

I find it hard to believe my subsidy should justifiably go from 1232 in 2021 to 929 in 2022. That leaves me with a $300 monthly premium which I cannot pay on a 1500/month income (before taxes), when my premium was $5 in 2021. How am I supposed to pay that after mortgage, HOA, utilities, internet, estimated taxes, back taxes and grocery???? AND, The American Rescue Plan of October 2021 didn’t even figure into that. They did absolutely nothing with it for my plan and there is no one to speak to on this matter. I have appealed but it doesn’t look promising. Obamacare is behaving like any other money-grubbing private company.

Louise Norris
Editor
6 months ago
Reply to  Penny

Penny, are there any new insurers offering plans in your area for 2022? If so, that could be the reason your subsidy is dropping, if the new insurers have priced their plans lower than the current insurers. Here’s more about how that works: https://www.healthinsurance.org/blog/how-new-carriers-in-your-marketplace-could-affect-your-coverage-options/
If your income is $1,500/month, you should be eligible for a premium-free benchmark plan (second-lowest-cost silver plan). $1,500/month is less than 150% of the poverty level, which means you qualify for a subsidy that will fully cover the cost of the benchmark plan (true in both 2021 and 2022). But if you’ve selected a plan that’s more expensive than the benchmark plan, you have to pay the difference. It’s possible that you had a plan that was just slightly more expensive than the benchmark in 2021, but if a new (lower-cost) benchmark plan has moved into the area, it would reduce the size of your subsidy and make your after-subsidy premiums higher in 2022.
If you want to let us know the specifics, we’re happy to look into this for you and explain it in more detail (we’d need to know your age, zip code, and the plan you currently have).

Sheri
Sheri
6 months ago

How does pass through business income affect subsidies? For example, if a business owner (with a household size of 4) has $100k in pass through income on 2021 tax returns and the business owner has also taken 50k in owner draws from the same company, and has 50k in spouse income, would the magi be $200k…therefore resulting in no subsidy?

Last edited 6 months ago by Sheri
Louise Norris
Editor
6 months ago
Reply to  Sheri

Here’s how MAGI is calculated under the ACA: https://www.healthinsurance.org/glossary/modified-adjusted-gross-income-magi/

It starts with your AGI from your tax return. Then, if you have non-taxable Social Security benefits, tax-exempt interest, or foreign earned income, you need to add those back to your AGI in order to get your ACA-specific MAGI.

I recommend that you consult with one, as I cannot give you tax advice. But from what you’re describing, assuming all of that income is taxable, it does sound like a MAGI of $200k. That doesn’t necessarily mean that you’re not eligible for a subsidy, since there’s no income cap for subsidy eligibility in 2022. But if the cost of the benchmark plan would be no more than 8.5% of your income, you wouldn’t be eligible for a subsidy.

This article might be helpful, in terms of understanding how contributions to tax-advantaged retirement accounts can lower your MAGI: https://www.healthinsurance.org/faqs/with-my-income-im-barely-over-the-eligibility-limit-for-a-premium-subsidy-is-there-anything-i-can-do-to-lower-my-income-so-i-become-eligible/

Lee
Lee
5 months ago

My mother is married but files taxes separately from my father. She wants to apply for a tax subsidy for health insurance but I know that married couples who file taxes separately don’t qualify. Someone mentioned that if she submits the right documentation she’ll qualify. Is that true? or is there any way to qualify for a tax subsidy?

Louise Norris
Editor
5 months ago
Reply to  Lee

Most married couples are required to file jointly in order to receive any premium tax credits. The only exceptions are for certain situations in which the spouses live apart from each other, which can include domestic violence/spousal abandonment situations. Here’s more about this: https://www.healthinsurance.org/faqs/my-wife-and-i-each-make-about-40000-a-year-if-we-file-our-taxes-separately-can-we-each-qualify-for-an-exchange-subsidy/

Dan
Dan
5 months ago

How can a self employed person exist in this system? My income goes up and down every year so the price of insurance goes from barely affordable to not even close to being able to pay for it?

I’ve had three bad years and in my low 60s (not much prospects out there). Last year, to survive I sold a family heirloom which blew out my AGI but it made up for lost money from the year before and the bad year last year. So this bad year, for subsidies my numbers are astronomical due to the item I had to sell last year. Are there special cases or are the numbers for qualifications set in stone? I’ll have to drop insurance totally for next year as I have pre-existing conditions and getting regular insurance would be impossible. What a disappointment our healthcare system has become.

Louise Norris
Editor
5 months ago
Reply to  Dan

Although you have to project your income a year in advance, your actual subsidy amount is based on income you actually earn during the year. So an item that you sold last year would not affect your subsidies for this year (unless the income has been paid to you over a long period of time, and you were still receiving it in 2021).

This is sometimes confusing, as people assume that their most recent tax return is being used to determine their subsidies. But that’s not the case For 2021, you had to project your income and your subsidies were based on that projection. When you file your income tax return for 2021, they will reconcile what you actually earned compared with what you projected, and adjust your 2021 premium tax credits if necessary.

When you’re enrolling for 2022, it will be a fresh slate: You’ll be projecting income for 2022, and that will get reconciled on your 2022 tax return. But anything you earned in years prior to 2022 will not be part of the equation.

shankar
shankar
5 months ago

 qualify for a subsidy that will fully cover the cost of the benchmark plan please tell me how to find this plan
we are two
our total MAGI $24000
we live in VA
zip 20152
I am citizen age 78+ my wife is green card holder age 72 +
we are not eligible for Medicare as we do not have 40 points as said by social security
I am happy with your in depth knowledge of ACA
thank you
shankar

Louise Norris
Editor
5 months ago
Reply to  shankar

The marketplace in Virginia is HealthCare.gov: https://www.healthcare.gov/ If you project an income of $24,000 for 2022, it’s going to show that you’re eligible for Medicaid, as that would be just slightly under 138% of the poverty level for a household of two (your wife might still be eligible for subsidies in that case, if she hasn’t been in the US for at least five years). But if you project an income of $24,100, it will show that you’re eligible for a substantial premium tax credit of more than $2,000/month.

You’ll then see a total of 64 available plans. You should focus on the Silver plans, as they’ll have additional cost-sharing reductions built-in, which means your out-of-pocket costs will be a lot lower than they’d otherwise be. There are 24 Silver plans available to you, including one that will cost you nothing at all after the subsidy is applied.

We recommend that you seek out a broker or Navigator in your area who can help you sort through the available options and determine which one will best fit your needs. Keep in mind that each plan will have its own list of in-network doctors and medical facilities, as well as its own covered prescription drug list.

Mark
Mark
4 months ago

I filed separately last year but will file jointly this year, can I qualify for financial assistance?

Louise Norris
Editor
4 months ago
Reply to  Mark

It will depend on your total household income and whether you’re eligible for an employer-sponsored plan, etc. But yes, assuming that your household income makes you eligible for a premium tax credit, the fact that you’ll be filing jointly for 2022 will allow you to claim the premium tax credit for 2022. You’ll apply for the premium tax credit based on your projected income for 2022, and you’ll reconcile it on your 2022 tax return. Nothing about your 2021 tax return or filing status will be applicable when you’re enrolling in 2022 coverage.

Mark
Mark
4 months ago
Reply to  Mark

Thanks!! I really appreciate it. Great answer.

Gayla
Gayla
3 months ago

( ACA ” GLITCH” Claws ) UGH Who Knew? Help Needed Please.

I got my self in a bit of a ” health insurance dilemma / crises” because of my Husbands high cost of medical premiums monthly / annually for myself’ I had applied for a subsidy through ACA’ I was accepted & chose my new medical insurance w/ new fees that was much lower then husbands health plan, like a 1/3 less then what I was paying’ I Canceled my medical insurance’ through Hubs Employer’ feeling like we are finally getting a break & well needed assistance.

I had called ACA back to ask about my new coverage & details’ after she reviewed my application she said I don’t ” Qualify” because my ” Husband’s Employer Offers There Employee’s Spouses Medical Insurance ” regardless if its expensive & my application was denied & deleted! unbelievable. She said ‘if my application was to go through, when the IRS catches that Husbands Employer offers Employee’s Spouses Medical Insurance I’d be required to pay back all monies!’ YIKES 🙁
I’m now uninsured & facing an even bigger hardship then before. What can I do in getting assistance & is it to late in the year?
I’m beyond frustrated w / this new found info i’ve discovered here in regards to ( ACA “The Glitch” claw ) glad I did though. It’s such a hardship for me & no doubt thousands of others thats in the very same situation.
Ca resident 92345. Thank You In Advance.

Louise Norris
Editor
3 months ago
Reply to  Gayla

I’m sorry you’re caught by the family glitch. Here’s more information about how it works: https://www.healthinsurance.org/obamacare/no-family-left-behind-by-obamacare/

California’s marketplace open enrollment period is still ongoing through January 31, but that’s just for coverage that you buy yourself. To re-enroll on your husband’s plan, his employer’s annual open enrollment period would have to still be ongoing. If it’s already ended for 2022 coverage, you wouldn’t be able to re-enroll unless you experience a qualifying event.

To clarify, you can still enroll in a plan through Covered California (through January 31), but you can’t get premium tax credits. So you do sitll have the option to pay full price for coverage through the marketplace and then switch back to your husband’s plan (if it’s more affordable than the full-price Covered California plan) when they offer their next annual enrollment period.

Agostino Terceira
Agostino Terceira
3 months ago

Hi…i just applied for ACA to start in April 1st as i will be retiring at the age of 62 However, I would like to find a part time to keep me going. If between me and my wife, we are to make 20,000 for the next two years till she retires, up to what amount am i able to make to keep the healthcare without penalties?

Louise Norris
Editor
3 months ago

Agostino,

This depends on where you live. Are you in a state that has expanded Medicaid (most have) or one of the dozen that have not? The income thresholds change each year, as the poverty level adjusts. I would suggest playing around with the subsidy calculator above, to see how your subsidy amount would change based on your income (note that it will currently only work for 2022; we’ll update it for 2023 numbers in the fall of 2022, when open enrollment begins for 2023 coverage).

Here’s some basic info that might be useful in your planning:

For 2022 coverage, a couple in a state that HAS expanded Medicaid would need to earn more than $24,040 in order to qualify for subsidies (less than that would put you on Medicaid instead). And in a state that HAS NOT expanded Medicaid, you’d have to earn at least $17,420 in order to qualify for subsidies (less than that would put you in the coverage gap, which means you wouldn’t be eligible for assistance at all: https://www.healthinsurance.org/faqs/what-is-the-medicaid-coverage-gap-and-who-does-it-affect/)

For 2023 coverage, those numbers will increase to $25,268 and $18,310, respectively. Beyond that, we won’t know until the new poverty level numbers are published each year.

On the upper end of the spectrum, you can earn quite a bit more and still qualify for subsidies. But the specific amount will depend on where you live. In 2022, there’s no set income cap for subsidy eligibility: https://www.healthinsurance.org/obamacare/beware-obamacares-subsidy-cliff/ It may or may not return in 2023, depending on what Congress does this year.

Les
Les
2 months ago

I will be switching to Medicare on 4/1/2022 so my ACA subsidy will be for only the first three months of 2022. I watch my income to make sure I stay within the ACA limits for receiving the PTC. Is there a way for me to calculate what I can earn in 2022 given that I am only participating in ACA for 3 months? Will the subsidy calc on the 8962 be based on my Jan – Mar income or will it in some way be based on my income for the entire year?

Last edited 2 months ago by Les
Louise Norris
Editor
22 days ago
Reply to  Les

Les,
Your subsidy amount for 2022 will be based on your full income for the year, but it’s then divided up into 12 monthly amounts. So when you’re filling out Form 8962 next spring, your full income for all of 2022 will be used to get your total subsidy amount. That will then be divided by 12 to get your monthly subsidy amount. The fact that you switched to Medicare in April 2022 will mean that you’re not subsidy-eligible for April – December, so the form will just show the monthly subsidy amount for January, February, and March.
But this is potentially important if you have flexibility in terms of planning your income for the rest of the year. If your income increases significantly (due to a severance package or withdrawal from a retirement account, for example), it could end up resulting in you having to repay your PTC for the first quarter of the year.

bobby hussey
bobby hussey
23 days ago

I have a premium tax credit this year through my health care plan when it was applied my refund went way up is this normal?

Louise Norris
Editor
22 days ago
Reply to  bobby hussey

Yes, the premium tax credit will make your refund larger if the premium tax credit that was paid on your behalf during the year was smaller than it should have been. The refunds being paid by the IRS this spring are for 2021, so this would be for the premium tax credit that you received (or should have received) last year. Here’s more about how premium tax credit reconciliation works: https://www.healthinsurance.org/faqs/should-i-take-my-aca-premium-subsidy-during-the-plan-year-or-claim-it-at-tax-time/

bobby hussey
bobby hussey
22 days ago
Reply to  Louise Norris

Thank you Mr. Norris for helping me understand the ptc better. I appreciate it very much.

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