What is the difference between subsidies, premium assistance, tax credits: which apply to me and how do I get them?

Subsidy, premium assistance, premium assistance credit, premium assistance tax credit, tax credit are all terms that are used interchangeably to describe money available to assist with the payment of monthly health insurance premiums for people that qualify for help.

What is a health insurance premium?

A health insurance premium is an amount payable to an insurance company, usually monthly, for health care coverage to remain available.

How do I know if I qualify for help with my monthly health insurance premiums?

Eligibility is based sliding scale, in accordance with the federal poverty level, issued yearly by the Department of Health and Human Services. Basically, the sliding scale begins at $17,235 and ends at $45,960 for individuals; and begins at $35,000 and ends at $94,000 for a family of four. To learn more about this credit, click here.

Is there anything else that affects my eligibility for premium assistance credit?

Yes. If you are offered affordable health insurance at work, you are not eligible for the credit.

What if my spouse is offered affordable insurance through work, but myself and the kids are not?

As of now, you are not eligible for premium assistance credit because of a loophole in the Affordable Care Act that requires employers with more than 50 full time employees, and ONLY employees, to offer affordable coverage. Because the coverage is affordable to the employee, it renders the entire family ineligible for the credit. Congress is working to close this loophole, stay tuned, and check regularly for updates.

How do I get the premium assistance credit if I qualify?

At the time you are buying health insurance, you apply for it with Covered California, or the exchange available in your state.

But I still have no idea how much it will cost, how can I get an idea of what I will be paying with and without subsidy?

Starting October 1, 2014 you can get a quote, that is when the plans go on sale. Until then, sample rates have been released, to help with budgeting.

So I go to the exchange to buy insurance and get my subsidy, can an agent help me too?

Yes. An agent can sell plans offered by the exchange as long as they have been certified to do so.

What is the advantage of using an agent and not just going straight to the exchange?

An agent’s services are free to you! Health care reform has made health insurance accessible to everyone, but it has not made it any less confusing. Agents have the most experience with health plans, health carriers, insurance terms, and practical health plan advice. Plus, if you have any confusion in using the health insurance once you have it, you can call your agent personally.

Click here for links to more information about health care reform and Covered CA.