Coverage Costs
Understand the costs associated with health insurance, including premiums, deductibles, and out-of-pocket maximums.
Premium
The amount you pay for your health insurance every month.
Deductible
The amount you pay for covered health care services before your insurance plan starts to pay.
Copayment
A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.
Out-of-pocket Maximum
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.
Advanced Premium Tax Credits (APTCs)
Lower your monthly insurance costs with federal subsidies
What Are Premium Tax Credits?
Advanced Premium Tax Credits (APTCs) are federal subsidies that help lower your monthly health insurance premium costs. These credits are paid directly to your insurance company, reducing what you pay each month.
You can choose to receive all, some, or none of your credit in advance. Any difference is reconciled when you file your federal income tax return.
Who Is Eligible?
To qualify for premium tax credits, you must:
- •Have a household income between 100% and 400% of the Federal Poverty Level (FPL)
- •Not be eligible for affordable employer-sponsored coverage that meets minimum value standards, unless your employer coverage is deemed unaffordable. Check affordability here.
- •Not be eligible for Medicare, Medicaid, CHIP, or other qualifying coverage
- •Be a U.S. citizen or lawfully present immigrant
- •Not be claimed as a dependent by another person
Understanding MAGI (Modified Adjusted Gross Income)
Premium tax credits are calculated based on your household's Modified Adjusted Gross Income (MAGI). Understanding MAGI helps you prepare the right information when applying for coverage.
What is MAGI?
MAGI is your Adjusted Gross Income (AGI) plus certain deductions added back in. For most people, MAGI is very close to or the same as AGI.
MAGI includes:
- • Wages, salaries, and tips
- • Self-employment income
- • Interest and dividend income
- • Social Security benefits (taxable portion)
- • Retirement distributions (IRA, 401k)
- • Alimony received (for divorces before 2019)
- • Foreign earned income
- • Tax-exempt interest
What to Have Ready:
When applying for coverage online or speaking with an agent, have these documents ready to accurately estimate your MAGI:
- •Most recent tax return (Form 1040) - Your AGI is on line 11
- •Recent pay stubs - If your income has changed since your last tax return
- •W-2 forms - For wage and salary information
- •1099 forms - For self-employment, interest, dividends, retirement income
- •Social Security statements - If you receive Social Security benefits
📋 Good News!
You don't need to have these documents in hand to apply or get a quote. We can work with your best estimates. The Marketplace may request documentation later for verification purposes, but don't worry—we're here to help guide you through that entire process. Our team will support you every step of the way so you don't have to stress about it.
Important: Your eligibility and subsidy amount are based on your projected income for the coverage year, not your previous year's income. If you expect your income to change significantly, let your agent know so they can help you estimate accurately.
How to Get Started
Ready to find out how much you could save with premium tax credits? We make it easy:
Get a Personalized Quote
Fill out our personalized quote form and we'll determine how much in subsidies you may be eligible for.
Get Your QuoteSpeak with a Certified Agent
Prefer to talk with someone? Call us to speak with one of our certified Marketplace agents who can help determine your eligibility for subsidies.
📞(888) 548-9525