How to Qualify for Subsidized Health Insurance

Subsidized health insurance, just like unsubsidized health insurance, is only available during the Annual Enrollment Period (AEP), unless you are experiencing a Qualifying Life Event (QLE), such as: the birth of a child, marriage, involuntary loss of minimum essential coverage, etc.

[More details on QLE’s can be found here.]

If you are enrolling during the Annual Enrollment Period, or you experienced a QLE and are enrolling through a Special Enrollment Period (SEP), you will be able to apply for subsidized health insurance through a state or Federal Marketplace.

[You can see if you qualify for an SEP here.]

It’s important to keep in mind that subsidized health insurance is only available for health plans that you enroll in through a state or Federal Marketplace that was established under the Affordable Care Act. If you select a plan that is not offered on either the Federal Marketplace, or through your state-run Marketplace, that plan will not be eligible for subsidies.

If your household size and income qualifies you for health insurance subsidies, the government will pay a portion of your health insurance premium. You may elect to receive your subsidy in the form or a lump sum tax credit paid to you when you file your taxes, or in the form of monthly insurance premium subsidies paid directly to your insurance provider.

How to Qualify for Insurance Premium Subsidies:

If you would like to qualify for subsidized health insurance, the first and best recommendation is that you see an authorized agent – like the ones available at WNC Health Insurance. Using one of these agents does not cost you any additional expense and may result in a significant savings of money and time.

Your agent, utilizing the experience that he or she has gathered during hundreds of other similar applications, will guide you through the health insurance enrollment application. In North Carolina, that means completing an application at HealthCare.gov. During the application process, you will provide detailed information on your household size and annual family income, including:

  • Birthdates
  • Expected Earnings for the Current Year
  • Expected Earnings for the Following (Insured) Year
  • Employer Contact Information
  • Any Existing Insurance Coverage (Employer/Group or Private Insurance)

This information will be used to determine your 1) eligibility for enrollment in the Marketplace and 2) the amount of insurance premium subsidies you qualify for.

You will want to be careful not to underestimate your expected annual household income for the insured year. If you end up making more than what you state in your application, and receive a bigger health insurance subsidy than you actually would have qualified for because of it, you will have to pay back any overpaid subsidies when filing your taxes. Likewise, if you underestimate your income, and receive a smaller subsidy than you actually qualified for, you will be paid any subsidies due to you when filing your tax return.

Your agent will create a “paper trail” for you as you apply. Since you will be working with several different entities in the acquisition of subsidized health insurance, it is smart to keep good records of your interaction with each one. This is another good reason to use an agent, who will keep track of the enrollment process for you!

After your eligibility for insurance premium subsidies has been determined, your agent will assist you in choosing the best health insurance plan for your family. Subsidized health insurance can prove to be a tremendous benefit to your family’s health and well-being, without being a detriment to your monthly budget.

Ready to get started? Call 828.348.2583 to get in touch with a licensed agent at WNC Health Insurance.