Get help paying

The key goal of Obamacare is to make health insurance available and affordable to all U.S. residents. There’s an annual open enrollment period in the marketplace when you can apply for:

2015 open enrollment runs from November 15, 2014 to February 15, 2015. Certain life events qualify you for a special open enrollment period that lasts 60 days from the date of the event.

Subsidies for monthly premiums

You may qualify for a tax credit subsidy that discounts your health insurance premiums. (Here’s how you qualify.) You apply for this subsidy during open enrollment at the health insurance marketplace. The government calculates how much you qualify for, and pays that subsidy amount directly to the insurance company. You only need to pay the remaining portion of the premium to the company, usually on a monthly basis.

This subsidy can be applied only to insurance from the marketplace, not for insurance from an employer, a private insurer, Medicare or Medicaid.

Subsidies for medical bills

During open enrollment, cost-sharing subsidies will be available to individuals and families with incomes below about $28,725 for an individual or $58,875 for a family of four who buy a Silver plan through the health insurance marketplace. The government will calculate how much assistance you qualify for, then reduce the amount you are charged for expenses such as doctor copays and health insurance deductibles. The lower your income, the less you will have to pay in out-of-pocket costs.

Who qualifies for subsidies

To qualify for financial assistance that can lower your monthly health care premiums and/or lower your out-of-pocket costs, such as copays and deductibles, you must:

  • Live in the United States
  • Be a U.S. citizen or national
  • Have a household income between the poverty level and four times the poverty level (In 2013, that’s $11,490 to $45,960 for individuals, and $23,550 to $94,200 for a family of four)
  • Not be eligible for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP)
  • Not have access to affordable coverage through your employer.

How you get your subsidy money

If you qualify for the subsidy that lowers the cost of your monthly insurance premiums, the money is paid directly to the insurance company by the government for you.

If you qualify for the subsidy that lowers the amount you have to pay for doctor visit copays or for your annual deductible, you will be charged a lower fee up front. For example, you may be charged $20 for an office visit instead of $30.

How subsidies are calculated

If you qualify for help, the amount you get is determined using a sliding scale. The lower your income, the larger your subsidy.

Examples:

  • If you make $17,235 a year, you will pay no more than 4% of your income, or $57 a month.
  • If you make between $34,470 and $45,960, you will pay a maximum of 9.5% of income, or $364 a month. The federal government covers the rest.
  • If you earn more than $45,960 (more than $94,200 for a family of four), you pay the entire amount for the plan you choose.

What you can use your health care subsidy for

During open enrollment, You can use your tax credit subsidy to purchase a plan in the marketplace. If you choose a higher-priced plan than the Silver level (such as Gold), your subsidy will be the same and you will pay the difference on the higher monthly premium. For example, if your monthly subsidy is $362, and the Gold level plan costs $450, you would pay $88 a month ($450 minus $362).

If your employer-sponsored coverage is too expensive

If your employer offers you insurance coverage but it’s not affordable, you may qualify for help paying for insurance during open enrollment if…

  • Your share of the cost of the insurance premium is more than 9.5 percent of your annual household income, or
  • Your employer’s insurance plan covers, on average, less than 60 percent of your medical expenses, leaving you to cover 40 percent or more.

About Medicaid

Medicaid is a government program that provides health insurance coverage to low-income U.S. citizens and their children. If you’re eligible, you receive free or low-cost health care through a managed care model that's often an HMO.

Since Medicaid eligibility is expanding in some states under the Affordable Care Act, you may be eligible for Medicaid now in 2014, even if you weren't in the past. In states that expanded the program, Medicaid will now be offered to individuals under age 65 with income less than about $15,302 ($31,155 for a family of four). You can apply at any time at Medicaid.gov.

How to qualify and apply for Medicaid

You may qualify for this program now or in 2014. Here are two ways to apply:

  • Find your state’s Medicaid website. You can apply right now and find out if you qualify.
  • Apply for insurance at the health insurance marketplace. By completing the application, you can find out which programs you qualify for. If you (or a family member) are Medicaid eligible, Medicaid will automatically be alerted so they can contact you.

About Medicare

Medicare is a federal health insurance program primarily for U.S. residents who are 65 and older. Medicare is also available to people with certain illnesses or disabilities. If you are already enrolled in Medicare, you don’t need to make any changes to your health care plan. Having Medicare meets the Obamacare requirement that all U.S. residents have health insurance in 2014.

How to qualify and apply for Medicare

You may qualify for Medicare, even if you are not 65 or older, if you are disabled or meet other qualifications. To find out if you are eligible for Medicare, visit Medicare.gov. If you are eligible, you can either apply online or at your local Social Security office.

Children’s Health Insurance Program (CHIP)

If your children need health insurance, they may qualify for the Children’s Health Insurance Program (CHIP). This federal program provides comprehensive low-cost coverage for children whose families earn too much money to qualify for Medicaid. In some states, CHIP is also available for parents and pregnant women. To apply, you can:

  • Fill out a marketplace application to find out which programs you and your family qualify for. And, if it looks like someone in your family qualifies for CHIP, the marketplace will have the CHIP agency contact you.
  • Visit www.insurekidsnow.gov, or call (877) 543-7669.