Do I Qualify for ACA Subsidies? A Simple Guide to Checking Your Eligibility

Finding affordable health insurance can feel overwhelming, but ACA subsidies can significantly lower your costs—if you qualify. These financial assistance programs help reduce monthly premiums and out-of-pocket expenses, making health coverage more accessible for individuals and families.

In this guide, we’ll break down who qualifies for ACA subsidies, how to check your eligibility, and what tools can help you estimate your savings.

What Are ACA Subsidies?

Under the Affordable Care Act (ACA), two main types of financial assistance are available for those purchasing insurance through the Health Insurance Marketplace:

✅ Premium Tax Credits (PTCs): Reduce your monthly health insurance premium costs.
✅ Cost-Sharing Reductions (CSRs): Lower your deductibles, copayments, and out-of-pocket expenses (available only with Silver plans).

The amount you qualify for depends on factors like your household income, family size, and location.

How to Check If You Qualify for ACA Subsidies

1. Determine Your Household Income

ACA subsidies are primarily based on your Modified Adjusted Gross Income (MAGI), which includes:

• Wages, salaries, and tips

• Self-employment income

• Unemployment benefits

• Social Security payments (excluding SSI)

• Rental income and investments

💡 Key rule: If your income falls between 100% and 400% of the Federal Poverty Level (FPL), you likely qualify for Premium Tax Credits. In some states, even incomes above 400% FPL may be eligible for subsidies under recent policy changes.

2. Use an ACA Subsidy Calculator

Want a quick estimate? Try these free online tools:

🔹 HealthCare.gov’s Subsidy Estimator – Official Marketplace tool for checking subsidy eligibility.
🔹 KFF Health Insurance Calculator – A user-friendly estimator from the Kaiser Family Foundation.
🔹 State Marketplace Websites – If your state has its own health exchange, they often provide subsidy calculators.

Simply enter your income, household size, and location to see your estimated monthly premium reductions and out-of-pocket savings.

3. Check for Cost-Sharing Reductions (CSRs)

If your income is between 100% and 250% of the FPL, you may qualify for extra savings on Silver-tier ACA plans through Cost-Sharing Reductions (CSRs). This means:

✔️ Lower deductibles
✔️ Reduced copays and coinsurance
✔️ Smaller out-of-pocket maximums

💡 Example: A family of four earning $40,000 per year could see substantial savings on copayments and deductibles with a Silver plan.

What If My Income Changes?

Your subsidy amount is based on your estimated income for the year—but life happens! If you:

🔹 Get a raise or new job → Update your Marketplace account to avoid owing money at tax time.

🔹 Lose income or have a baby → You may qualify for increased subsidies or a Special Enrollment Period (SEP) to change your plan.

Need Help Checking Your ACA Subsidy Eligibility?

Navigating ACA subsidies can feel complicated, but you don’t have to do it alone. At Pereyda Financial, we help individuals and families find affordable, high-quality health insurance with the maximum savings available.

📞 Call us today (915) 265-5387 for a free consultation, or use the subsidy calculators above to see how much you can save!