Subsidies and Tax Credits

  • Find out if you qualify

    Here's some good news: The majority of Washington state residents who buy individual health coverage are eligible for financial help with the cost of their health plan. Your annual household income and the number of people in your household determine whether you qualify. Note that your eligibility must be re-verified each year when you renew your health plan.

    Financial help is available only if you aren't offered health insurance through your employer or your spouse’s employer that meets certain minimum standards for coverage and affordability. If you have a plan from Medicare or certain other government programs, you won't be eligible for a subsidy or tax credit.

    In 2015, 78% of Washington state residents who enrolled over the exchange qualified for a subsidy.*

    Answer a few questions to find out if you might qualify.

  • Find out if you might qualify for a subsidy and how much help you could get.

    What is your age?

  • Two types of financial help are available

    There are two types of financial help or subsidies: tax credits and cost-share reductions.

    The government measures people's incomes in relation to the federal poverty level (FPL). If your annual household income is less than four times or 400% of the federal poverty level, you may qualify for a tax credit. If your income is less than 2.5 times or 250% 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 $47,080 $29,425
    2 $63,720 $39,825
    3 $80,360 $50,225
    4 $97,000 $60,625
    5 $113,640 $71,025

    Premera can help you learn whether you qualify for financial help with your health plan costs. Call us at 800-722-1471 with any questions.

    Tax credits for health plan premiums

    The most common form of financial help is the tax credit for health plan premiums. This credit is provided by 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're 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 through Washington Healthplanfinder, and apply for a tax credit.

    How much will you receive?

    The amount you receive will depend on both your income and the cost of the plan you choose to purchase. Try this calculator to see if you might qualify.

    Cost-share reductions: Lowering costs when you receive 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. These are called cost-share

    How do you apply for cost-share reductions?

    The cost-share reduction is available only if you purchase a silver plan through Washington Healthplanfinder. Premera offers silver plans that are eligible for these cost reductions. We can help you with the application process through Washington Healthplanfinder. Call us at 800-722-1471 with any questions.

    Health plan coverage and your taxes

    The Internal Revenue Service (IRS) requires that you provide information about your health plan coverage on your annual tax return.

    If you receive coverage through an employer or directly through Premera, you'll need to confirm that you had coverage for the year. If you didn't have coverage for at least 10 months of 2015, you may have to pay a penalty.

    If you enrolled through Washington Healthplanfinder, you'll receive a statement from them (Form 1095) that you'll need to complete your tax return.

    If you received a tax credit or are facing a penalty for not having coverage, you may want to use a tax or 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, on the Affordable Care Act page of