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 2021 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 2022.
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 2021 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 2022.
2020 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 2022- 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.
We will use this estimate to determine your APTC ( Advance Premium Tax Credit ) or the premium discount subsidy to reduce your insurance premium.
In thinking about your income for 2022, we suggest going a little higher rather than lower. Your income estimate is reconciled with your actual income when you do your taxes for 2021 tax year (in 2022). It'll be nice to get some dollars back at that point rather than pay more.
As the premium of the benchmark Silver plan has decreased–so too the premium subsidy has decreased as well. If you have similar income estimate in 2022 as 2021 - the actual subsidy will decrease for 2022.
In thinking about your income for 2022, we suggest going a little higher rather than lower. Your income estimate is reconciled with your actual income when you do your taxes for 2021 tax year (in 2022). It'll be nice to get some dollars back at that point rather than pay more.
As the premium of the benchmark Silver plan has decreased–so too the premium subsidy has decreased as well. If you have similar income estimate in 2022 as 2021 - the actual subsidy will decrease for 2022.
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