Subsidy vs. cost-sharing

The Affordable Care Act (ACA) provides two separate types of assistance with your healthcare costs when you purchase a plan from a participating Health Marketplace: subsidies in the form of premium tax credits, and cost-sharing reductions (CSR).

• Subsidies are available for households whose income is between 100% and 400% of the Federal Poverty Level. To qualify for subsidies, you must be ineligible for affordable employer health insurance or other government health insurance programs, such as Medicaid, Medicare, or Veterans Affairs (VA) benefits. These subsidies can be applied directly to your health plan to reduce the amount of your premium payments.
• Cost-sharing reductions (CSR) are available for households whose income is between 100% and 250% of the Federal Poverty Level. Cost-sharing reductions lower the amount you pay for healthcare services like doctor copays, deductible, and out-of-pocket maximums. The level of help you receive is based on your income, and can only be applied to Silver plans.

Click here to learn more about subsidies and cost-sharing.

Your healthcare costs

Your healthcare costs are a total of a number of different components, as follows:

• Premium: You pay this amount each month to maintain your health plan.
• Copays: You're responsible for this amount each time you visit a provider or fill a prescription.
• Deductible: You'll pay this much for services before your health plan begins paying for hospital/procedure costs.
• Out-of-pocket maximum: Once you've paid this much towards services, your health plan will cover any remaining costs for the remainder of the plan year.

Other forms of assistance

If you're not eligible for assistance with your ACA costs in the form of a subsidy, there are a number of other government programs that may help you with your healthcare costs.

• Medicare: Medicare is a form of healthcare sponsored by the federal government. Normally provided to those over 65 years of age, it is also available for individuals with certain health conditions.
• Medicaid: This is a form of healthcare assistance provided by your state to lower-income individuals. You can check your state's program to see if you're eligible.
• CHIP: The Children's Health Insurance Program, or CHIP, is a state-sponsored form of healthcare assistance available for those under the age of 19.
• Veteran's programs: U.S. Veterans have a number of programs that can provide assistance with healthcare, such as TRI-Care. If you're a veteran, you can contact your Veteran's Affairs (VA) office to see if there are any available to you.