Subsidies and Tax Credits

  • More than half of Americans who buy individual health coverage are eligible for financial help with the cost of their health plan. Whether you qualify depends on your annual household income and the number of people in your household.

    Financial help is available only if you cannot get health insurance that meets certain minimum coverage and affordability standards through your employer or your spouse’s employer. You are not eligible for financial help if you are on Medicare or certain other government programs. Your financial eligibility will be re-verified each year when you renew your health plan.

  • 55% of uninsured Washington residents may qualify for a subsidy.*

    Answer a few questions to find out if you might qualify, starting with your age. 

    Adult 18 to 64
    Senior 65 or over
    * src: Kaiser Family Foundation.  
  • We can help

    A Premera health plan can be yours for little cost if you qualify. Premera can help you learn whether you qualify for financial help with your health plan costs and help you buy a plan. Call us at 800-722-1471 with any questions.

    Are you eligible for financial help? 

    There are two types of financial help or subsidies: tax credits and cost-share reductions. In addition, some people with low incomes may qualify for Medicaid; state and federal governments pick up the entire tab for this.

    The government measures people’s incomes in relation to the federal poverty level (FPL). If your annual household income is less than four times the federal poverty level (400 percent), you may qualify for a tax credit. If your income is less than 2.5 times (250 percent) of the FPL, you may qualify for cost-share reductions.

    Note: If your financial or family situation changes during the year, such as if you lose your job or change jobs, your employer no longer offers health coverage, or you have a baby or adopt a child, you may become eligible for financial assistance.

    This chart shows whether you might qualify for each type of help.

    People in household Maximum income for tax credit (400% of FPL) Maximum income for cost-share reductions (250% of FPL)
    1  $46,680 $29,175
    2  $62,920 $39,325
    3  $79,160 $49,475
    4  $95,400 $59,625
    5  $111,640 $69,775

    Tax credits

    The main form of help is the premium tax credit. This credit comes from the federal government and helps reduce the amount you have to pay each month toward the cost of your health coverage.

    How do you apply for tax credits? 

    If you are eligible for tax credits, you must purchase your health plan through a health exchange. In Washington, that’s the Washington Healthplanfinder. Premera can help you determine whether you qualify for financial assistance, help you sign up for a health plan, and apply for a tax credit. Call us at 800-722-1471 with any questions.

    How much will you get? 

    It depends! The tax credit is designed to reduce the percentage of your household income you pay for your health coverage. So the amount you get will depend on both your income and the cost of the plan you choose to purchase. Try this calculator to see what you may qualify for.

    Cost-share reductions: Lower costs when you need care

    The second type of financial help lowers the amount you pay when you receive care, such as visiting the doctor’s office or filling a prescription.

    How do you apply for cost-share reductions? 

    The cost-share reduction is only available if you purchase a silver-level plan through Washington Healthplanfinder. Call us at 800-722-1471 with any questions. We can help you with the application process through Washington Healthplanfinder.

    Premera offers several silver plans that are eligible for these cost reductions.

    Learn more about the cost-share subsidy in this short video from healthcare.gov.

    Health insurance and your taxes

    This year the Internal Revenue Service will require that you provide information on your health plan coverage.

    If you get coverage through an employer or directly through Premera, you will only need to confirm that you had coverage for the year. If you didn’t have coverage for at least 9 months of 2014 you may have to pay a penalty.

    If you enrolled through Washington Healthplanfinder you’ll receive a statement from them (form 1095-A) that will help you complete your tax return.

    If you either got a tax credit or are facing a penalty, you may want to use a tax filing service or speak with a financial advisor to make sure your tax return is correct.

    Find more information about how health coverage affects your tax filing, along with all the forms you might need, at healthcare.gov.