Save Money on Marketplace Health Insurance Plans

Posted in: News 2015

Save Money on Marketplace Health Insurance Plans

Financial aid through health exchanges related to the Federal Poverty Level

Are you or your friends and family members among the 8 in 10 current Marketplace enrollees that can save money on health insurance through tax credits and cost sharing reductions?

Last year 80 percent of Marketplace consumers received an average tax credit of $270 per month, and this year more than 70 percent of people could find plans for $75 or less per month after tax credits.

The Affordable Care Act (ACA) provides two financial assistance programs to help people lower their monthly premiums and their out-of-pocket expenses associated with health care visits. These programs include Premium Tax Credits (PTCs) and Cost Sharing Reductions (CSRs).

Depending on where you live, you may also be able to get help with any remaining insurance expenses from the Ryan White HIV/AIDS Program. Talk with your case manager or contact your local ADAP program before you start the enrollment process to find out what you qualify for and get help finding an affordable plan that covers treatment needs.

How do Premium Tax Credits and Cost-Sharing Reductions work?  

Individuals and families with qualifying incomes (see table) are eligible for a PTC, which reduces the cost of the monthly insurance premium. This tax credit applies to any level plan in the Marketplace (Bronze, Silver, Gold or Platinum). Many people choose to get their PTCs in advance (instead of at the end of the year) so they pay a lower premium each month. This makes it an APTC – the “A” is for “Advance”). Many ADAPs require clients to take the APTC, so check with your state ADAP about any requirements.  

Some of these individuals and families (see table) are also eligible for cost-sharing reductions, which are essentially discounted health care services. However, these discounts apply ONLY to the Sliver-level plans in the Marketplace.

There are four levels of plans in the Marketplace: Platinum, Gold, Silver and Bronze. The Platinum plan has the highest premium and the lowest out-of-pocket costs. The Silver plan is a good option for balancing the cost of the monthly premium with the out-of-pocket costs.

How much financial help are you eligible for?

Both PTCs and CSRs are estimated when you apply for health insurance based on your household size and anticipated income.

· People with incomes at or below 250% of the FPL are eligible for both PTCs and CSRs.

· People with incomes between 251-400% FPL are only eligible for PTCs.

In other words, the lower the income, the more financial assistance someone might be eligible for.

The table below shows these income limits in a variety of different sized households (or click here to do a quick check):

Remember to update income changes throughout the year!

Because income and household size may change during the year, anyone who receives financial assistance is required to file taxes at the end of the year. The IRS uses this information to make sure you received the correct amount of tax credit based on your actual income.

· If you overpaid, you will get a refund from the IRS (but remember that if the Ryan White Program helped pay your premiums then you’ll need to give your refund to them).

· If you underpaid, you’ll need to pay the difference at tax time so that you’re eligible for financial assistance next year.

To learn more about financial assistance in the health insurance Marketplace, watch this recording from the December 10 ACE TA Center webinar: Everything You Wanted to Know about Cost Sharing and Tax Credits in 2016.

In the meantime, remember that you must enroll by today, December 15th, in order to get coverage that begins January 1, 2016. Take action now so that you can start the year off knowing you’re covered!

By the ACE TA Center

The HRSA-supported ACE TA Center works with Ryan White HIV/AIDS Program grant recipients and sub-recipients to help diverse clients get enrolled in health coverage. Learn more at


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