Do I Qualify for Obama Care (Affordable Care Act or ACA) Subsidies in New York?

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Ways to Save Money on Obamacare in New York

There are three ways to reduce the cost of health plans under the Affordable Care Act in New York.

  1. You may be able to lower the cost of monthly premiums when you sign up for a private health insurance plan. Your savings will come in the form of a tax credit.
  2. You may be able to reduce your out-of-pocket costs -- including copayments, deductibles, and coinsurance -- with cost-sharing subsidies.
  3. You may qualify for free or low-cost coverage through Medicaid in New York, or your children may be able to obtain coverage through the Children’s Health Insurance Program (CHIP).

Each of these forms of assistance depends on your income and family size.

Many people who apply for coverage at the New York exchange will be eligible for some form of financial assistance. Read on to learn more about each option.

1. Lowering Premium Costs with Tax Credits

If you are under age 65 and not eligible for job-based health coverage or Medicaid, a tax credit -- called the Advance Premium Tax Credit -- may help you pay your monthly premiums.

The tax credit is available for those whose annual income is between 100% and 400% of the federal poverty level. The following income ranges will help you determine whether you qualify. (These amounts are based on the federal poverty level for 2014.)

  • $11,670 to $46,680 for individuals
  • $15,510 to $62,920 for a family of 2
  • $19,790 to $79.160 for a family of 3
  • $23,850 to $95,400 for a family of 4
  • $27,910 to $111,640 for a family of 5
  • $31,970 to $127,880 for a family of 6
  • $36,030 to $144,120 for a family of 7
  • $40,090 to $160,360 for a family of 8

If you qualify, you won’t have to wait until tax time to claim your credit. It can be sent directly to your insurer to immediately lower your premiums.

2. Reducing Out-of-Pocket Costs with Cost-Sharing Subsidies

Cost-sharing subsidies help you pay for out-of-pocket costs like co-pays and deductibles. They also lower the total amount you have to pay for health care in a given year. (The annual out-of-pocket spending limits for plans offered by NY State of Health will vary depending on the type of plan – platinum, gold, silver, or bronze. See How Much Does Obamacare Cost in New York?)

Cost-sharing subsidies are available for people earning between 100% and 250% of the federal poverty level. The limits below will help you determine whether you qualify. (These amounts are based on the federal poverty level for 2014.)

  • Up to $29,175 for individuals
  • Up to $39,325 for a family of 2
  • Up to $49,475 for a family of 3
  • Up to $59,625 for a family of 4
  • Up to $69,775 for a family of 5
  • Up to $79,925 for a family of 6
  • Up to $90,075 for a family of 7
  • Up to $100,225 for a family of 8

Note that these out-of-pocket savings are available only for silver plans. Generally, if you qualify for the subsidy, you’ll get the out-of-pocket benefits of a gold or platinum plan for the price of a silver plan.

Your final eligibility for cost-sharing subsidies will be determined when you apply for a health plan at NY State of Health.

3. Getting Free or Low-Cost Coverage through Medicaid or CHIP

You may qualify for free or low-cost coverage through Medicaid, or your children may be able to obtain coverage through the Children’s Health Insurance Program (CHIP).

Medicaid. If you are eligible for Medicaid, you will get free or low-cost health care. You will not need to buy a separate health plan through NY State of Health.

The good news is that New York is planning to expand Medicaid eligibility in 2014. That means that even if you were told you didn’t qualify for Medicaid in the past, you may be eligible under the new rules.

When you apply for health coverage at NY State of Health, the state will check your application against the Medicaid eligibility rules and tell you whether you qualify for Medicaid or the other savings options described above.

Children’s Health Insurance Program (CHIP). Even if you don’t qualify for Medicaid, your children may be eligible for the Children's Health Insurance Program (CHIP). Kids covered by CHIP don’t need to be included in another health plan.

When you apply for health coverage at NY State of Health, the state will check to see whether your children might qualify for CHIP. If so, it will alert the New York CHIP agency so your kids can get the coverage they need.

Learn more

You can learn the final costs for specific plans, including whether you qualify for subsidies or low-cost care programs, when you apply for insurance online at NY State of Health.



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