Please use these Resources for Determining Your Estimated Premium Subsidy
Federal Poverty Level (FPL)
A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.
The 2023 federal poverty level (FPL) income numbers below are used to calculate eligibility for Medicaid and the Children's Health Insurance Program (CHIP) and are used to calculate savings on Marketplace insurance plans for 2023.
A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.
The 2023 federal poverty level (FPL) income numbers below are used to calculate eligibility for Medicaid and the Children's Health Insurance Program (CHIP) and are used to calculate savings on Marketplace insurance plans for 2023.
2023 Poverty Guidelines Income Chart
How federal poverty levels are used to determine eligibility for reduced-cost health coverage:
- Income above 100%: If your income is in this range, in all states you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan.
- High Income above 400%: For 2023- the "Income Cap" has been eliminated. Your subsidy will be calculated as % of income. For a younger single person age 35, these subsidies start to fall off at $75,000. For family of 4, mid 50's, subsidies are available to $350,000 and beyond.
- Income below 138% FPL: If your income is below 138% FPL and your state has expanded Medicaid coverage, you qualify for Medicaid based only on your income.
- Income below 100% FPL: If your income falls below 100% FPL, you probably won’t qualify for savings on a Marketplace health insurance plan or for income-based Medicaid. NOT SUBSIDY.
- North Carolina has not yet expanded Medicaid.
Estimate Your Income for 2022
To determine the premium subsidy–the Marketplace uses your "MAGI" (Modified Adjusted Gross Income). PLUS the full value of any Social Security Income. This is your total income. Line 11 on your 1040.
Include:
- W-2 wages, salary for All household members.
- Self Employment Income ( net) - Lines 8.
- Any, All Social Security Income – Line 6 A.
- IRA, Pensions, Dividends – Lines 2b,3b,4b,5b.
- Capital Gains line 7.
- Minus line 10 – Adjustments- like IRA contributions.
- LINE 11 plus 6a – MAGI – “Where the Subsidy Magic Lives”
Click on Image To Enlarge
Remember -- Your Premium Discount / tax subsidy is based on your ESTIMATED Income.
When you do your taxes for 2023 – the IRS will reconcile your ACTUAL with your ESTIMATE.
If LOWER -- You may get the difference in the subsidy calculation back on your tax.
IF Your Income is HIGHER – You will be responsible for the difference on your 2023 tax.
We suggest you check your Estimated Income - found on your eligibility statement with your actual income several times a year. NOBODY likes surprises on their tax return.
If you work with a tax professional or CPA, share this with them. In our view, as they do your return and work on your behalf with IRS; it the THEIR responsibility to work on this for you.
When you do your taxes for 2023 – the IRS will reconcile your ACTUAL with your ESTIMATE.
If LOWER -- You may get the difference in the subsidy calculation back on your tax.
IF Your Income is HIGHER – You will be responsible for the difference on your 2023 tax.
We suggest you check your Estimated Income - found on your eligibility statement with your actual income several times a year. NOBODY likes surprises on their tax return.
If you work with a tax professional or CPA, share this with them. In our view, as they do your return and work on your behalf with IRS; it the THEIR responsibility to work on this for you.
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or call 1.800.Medicare to get information on all of your options.”
Trout Insurance is an independent authorized agency licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (Blue Cross NC). The content contained in this site is maintained by Trout Insurance. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. ®, SM Registered marks of the Blue Cross and Blue Shield Association.”
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