ACA-Income Table: do I qualify for a subsidy?

In 2014, there will be three primary tax-related changes for individuals and small businesses related to the Affordable Care Act. They pertain to Medicaid (OHP Oregon Health Plan), the ACA Small Employer Health Insurance Tax Credit, and the ‘subsidy’ to buy individual health insurance, aka the Advanced Tax Credit.

Bear in mind as you read below that exactly what constitutes a ‘household’ in the mind of Cover Oregon is not fully known. We also don’t know how they’ll attribute income per person as of yet. For example it appears that when children qualify for OHP coverage, the household income is now fully attributed to the adults in the household. In other words, if you have a family of 4 making $66,000 Modified Adjusted Gross Income ‘MAGI’ per year in 2014, the kids will get on OHP. But Cover Oregon now may say the household is now two people at $66,000 per year so the remaining adults would not qualify for a subsidy. Bottom line: it’s tricky and you should not make assumptions about subsidies, etc., until you receive a written notification from Cover Oregon.

  • Adults will be able to earn up to 138% of Federal Poverty Level and still qualify for the OHP.
  • Children of parents earning up to 300% of FPL will qualify for OHP.
  • Adults earning between 139 and 250% of FPL will be eligible for CSR ‘Cost Share Reduction’. CSR is available on Silver plans, and it means that the deductibles and copays will be shrunk down to make medical care more affordable. This is an additional/extra benefit above and beyond the subsidy for which these same people will qualify.
  • Household members earning less than 400% of FPL may qualify for a subsidy, but ONLY if they purchase new insurance through Cover Oregon.
  • The Small Employer Tax Credit, which started in 2010 will be expanded in 2014 but only for new group health insurance plans purchased through Cover Oregon.
2013 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS¬†STATES AND THE DISTRICT OF COLUMBIA, i.e. ‘Federal Poverty Level’ (http://aspe.hhs.gov/poverty/13poverty.cfm)
Persons in family/household Poverty guideline (100% of FPL) 138% of FPL (below this limit, adults may qualify for OHP) 250% of FPL (Cost Share Reduction applies between 139-250% of FPL. Silver plans only) 300% of FPL (below this limit, children may qualify for OHP) 400% of FPL (below this limit, adults may qualify for a subsidy through CoverOregon.com)
1 $11,490.00 $15,856.20 $28,725.00 $34,470 $45,960
2 $15,510.00 $21,403.80 $38,775.00 $46,530 $62,040
3 $19,530.00 $26,951.40 $48,825.00 $58,590 $78,120
4 $23,550.00 $32,499.00 $58,875.00 $70,650 $94,200
5 $27,570.00 $38,046.60 $68,925.00 $82,710 $110,280
6 $31,590.00 $43,594.20 $78,975.00 $94,770 $126,360
7 $35,610.00 $49,141.80 $89,025.00 $106,830 $142,440
 8* $39,630.00 $54,689.40 $99,075.00 $118,890 $158,520
* For families/households with more than 8 persons, add $4,020(to 100% of FPL) for each additional person.
Cover Oregon subsidy estimator: http://www.coveroregon.com/individual/browse