Help Paying Marketplace Premiums: The Basics

Who is eligible for Marketplace premium tax credits?

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Premium tax credits are available to U.S. citizens and lawfully present immigrants who purchase coverage in the Marketplace and who have income between 100% and 400% of the federal poverty level. Premium tax credits are also available to lawfully residing immigrants with incomes below 100% of the poverty line who are not eligible for Medicaid because of their immigration status. (Generally, immigrants must lawfully reside in the U.S. for five years before they can become eligible for Medicaid.)

In addition, to be eligible for the premium tax credits, individuals must not be eligible for public coverage—including Medicaid, the Children’s Health Insurance Program, Medicare, or military coverage—and must not have access to health insurance through an employer. (There is an exception in cases when the employer plan is unaffordable because the employee share of the premium exceeds 9.83% of the employee’s income in 2021. There is also an exception in cases where the employer plan doesn’t provide a minimum level of coverage.)

Four states supplement marketplace subsidies for their residents.  In California, people with income up to 600 percent of the poverty line can qualify for premium subsidies.  In New Jersey, subsidies are increased for residents with income up to 400 percent of poverty.  In Massachusetts, subsidies are increased for residents with income up to 300 percent of poverty.  Vermont also supplements premium and cost sharing subsidies.  Check these state marketplaces for more information.

Browse more questions in the Immigrants, Medicare and Employer-Sponsored Health Coverage sections.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.