The Health Insurance Marketplace: Income
When you get coverage through the Marketplace, you may be able to get lower costs on deductibles, copayments, and coinsurance. This will depend on your income. The Marketplace cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs. These savings are based on your income and family size.
Health insurance companies offering coverage through the Marketplace must lower the amount you pay out of pocket for essential health benefits if your household income is below the following amounts. Incomes below are based on 2013 numbers. They are likely to be slightly higher in 2014. Amounts are different for each family size, up to eight.
- Up to $28,725 for an individual
- Up to $38,775 for a family of two
- Up to $48,825 for a family of three
- Up to $58,875 for a family of four
- Up to $68,925 for a family of five
- Up to $78,975 for a family of six
- Up to $89,025 for a family of seven
- Up to $99,075 for a family of eight
When you apply for coverage in the Marketplace, you'll learn if you're eligible for these savings on out-of-pocket costs.
Out-of-pocket savings apply only to Silver plans.
Plans in the Marketplace are separated into 4 different categories: Bronze, Silver, Gold, and Platinum. These categories are based on how much of your medical costs you pay and how much the plan pays when you get medical care. They are not based on plan quality.
If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings. If you qualify for these savings, you'll get the out-of-pocket savings benefits of a Gold or Platinum plan for a Silver plan price. You can choose any category of plan, but you'll get the out-of-pocket savings only if you enroll in a Silver plan. You'll be able to choose your plan category when you fill out your Marketplace application.
U.S. Centers for Medicare & Medicaid Services, HealthCare.gov. (n.d.). Will I qualify for lower out-of-pocket costs? Retrieved May 31, 2015, from https://www.healthcare.gov/