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Determining if You Qualify for a Tax Subsidy

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Determining if You Qualify for a Tax Subsidy

Colleen McGuire

Updated: March 22, 2017    Published: February 4, 2015

The rate of uninsured Americans has dropped, hitting the lowest level of 12.9 percent at the end of 2014, which is a substantial reduction from 17.1 percent just a year earlier. A recent Gallup poll1 points to the Affordable Care Act’s requirement for Americans to have health insurance as the main driver for the decrease. Does this mean law-abiding citizens are pushing the uninsured rate down out of duty, or are financial benefits for buying a health insurance plan (or fear of a tax penalty) paving the way for coverage? Let’s look at the numbers.

Under the Affordable Care Act, also known as Obamacare, the law states that Americans who fall between 100 and 400 percent of the federal poverty level, depending on their state of residence, can qualify for financial aid to help pay for their health insurance plan. On average, those who qualify for a subsidy on their health insurance have an annual income under $46,680 as an individual, or under $95,400 for a family of four.2 However, subsidy amounts vary by ZIP code, and financial assistance for a family of four that report $45,000 in household income a year will depend on many state zoning factors. To estimate your financial eligibility, run your household income through’s subsidy calculator.

While the subsidy picture appears positive, there is one particular population that could be falling through the cracks. The group likely struggling with the healthcare law are individuals below the 100 percent poverty level in 22 states that did not expand their Medicaid programs. In those states, approximately 4 million “working poor” do not qualify for Medicaid nor do they qualify for a health insurance subsidy.But based on the law, they are required to buy a health insurance plan or pay a tax penalty, which for the 2014 tax year is $95 per person or 1 percent of their income, whichever is greater. States that did NOT expanded Medicaid for 2015 include: Alabama, Alaska, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin and Wyoming. The hopeful news is that seven of these 22 states are considering expansion of their state Medicaid programs, although no resolution has yet been announced.

Think you might qualify for a subsidy on your health insurance? You just might, but you need to hurry. Open enrollment closes February 15, 2015, and health insurance may not be purchased again until October 1, 2015, when open enrollment for 2015-2016 begins. Only those who experience a “qualifying event,” such as marriage, divorce, birth of a baby, or a change in jobs can enroll in a healthcare plan during the special open enrollment period of February 16-September 31, 2015.

Download the infographic: A 1-Minute Primer on Whether You Qualify For a Health Insurance Subsidy



1In U.S., Uninsured Rate Sinks to 12.9%.” Gallup Poll. January 7, 2015.

2Explaining HealthCare Reform. Questions about Health Insurance Subsidies.” Kaiser Family Foundation. October 27, 2014.

3”The Coverage Gap: Uninsured Poor Adults in States That Do No Expand Medicaid – An Update.” Kaiser Family Foundation. November 12, 2014.

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