Subsidy Eligibility
Enhanced Subsidies with Inflation Reduction Act (IRA)
Advanced Premium Tax Credit (APTC): A tax credit individuals can use to lower their monthly insurance payment (called the “premium”) when they enroll in a plan through the Health Insurance Marketplace. The tax credit is based on the individuals’ income estimate and household information on their Marketplace application. Individuals can buy health insurance through other sources, but the only way to get a tax credit is through the Health Insurance Marketplace. The American Rescue Plan Act (ARPA) of 2021 has provided increased savings and lower costs to consumers enrolling in Marketplace coverage. With ARPA, more people became eligible to qualify for subsidies including enrollees whose income is greater than 400 percent of the Federal Poverty Guidelines (FPL). Now signed into law, the Inflation Reduction Act extends the expanded premium tax credits through 2025.
Federal Poverty Guidelines (FPL): A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine member eligibility for certain programs and benefits, including savings on the Exchange, and Medicaid and CHIP coverage.
2023 Poverty Guidelines
The 2023 poverty guidelines* for the 48 Contiguous States and the District of Columbia are in effect as of January 16, 2023.
| Persons in family/household | Poverty Guideline |
|---|---|
| 1 | $14,580 |
| 2 | $19,720 |
| 3 | $24,860 |
| 4 | $30,000 |
| 5 | $35,140 |
| 6 | $40,280 |
| 7 | $45,420 |
| 8 | $50,560 |
*For families/households with more than 8 persons, add $5,140 for each additional person.
*Source: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines
Understanding Your 2023 OptimaFit® Individual and Family Health Plan Options
Individual health plans offer a variety of price options and are categorized by metallic tiers: Gold, Silver, and Bronze.
Categorizing plans by metallic tier makes it easier for you to compare plans based on their cost and coverage options. If you do not qualify for a subsidy, you may want to consider plans not offered on HealthCare.gov also known as "Off-Exchange" plans.
This chart provides an overview of health plan tiers to help you determine which metallic plan would be best for you.
| Gold | Silver | Bronze | |
|---|---|---|---|
| Monthly Premium | $$$ | $$ | $ |
| Percent of Healthcare Cost Covered | 80% | 70% | 60% |
| Good If... | You want to save on premium costs, while still reducing your out-of-pocket costs. | You need to balance monthly premium costs with out-of-pocket costs. | You don't plan to use a lot of healthcare services. |
Things to Consider
If you don't anticipate you will need a lot of healthcare services, you may want to consider a bronze or silver plan for a lower monthly premium; however, if you or a family member have an unexpected serious injury or illness, an OptimaFit Gold plan offers richer benefits and would cover more out-of-pocket costs.
