Key takeaways:
Under the Affordable Care Act (ACA), you may qualify for premium subsidies — discounts that reduce the monthly cost of your health insurance plan — as well as savings on out-of-pocket costs when you access care.
Subsidies are based on your estimated income in a coverage year. If your actual income is more than expected, this may result in a higher tax bill later.
There are income limits to qualify for financial help on your monthly premium and savings on out-of-pocket costs.
Changes to your income can also alter what you pay each month for your ACA health plan. Less income can increase the amount of financial help your household receives, and more income can reduce the amount you receive.
The Affordable Care Act is the 2010 comprehensive health law known as “Obamacare” or, simply, the ACA.
The Affordable Care Act offers financial help that will continue to make health plans accessible in the 2025 coverage year. The Centers for Medicare & Medicaid Services (CMS) reports that 4 out of 5 marketplace customers will be able to find a plan for $10 or less per month after subsidies.
Health insurance through an Affordable Care Act marketplace plan can help protect you from financial pain if you have an injury or illness. ACA plans are also a safety net for people who do not have access to job-based insurance or government insurance, such as Medicaid and Medicare.
Prescription Savings Are Just the Beginning
See what other benefits you qualify for—from cashback cards to cheaper insurance.
The ACA may allow you to receive a premium tax credit, or premium subsidy, based on your household’s size and income. This will help you save on the monthly cost of your health insurance plan.
Household income determines what you pay for Obamacare and how much you save. You qualify for a subsidy based on how your household income compares to the federal poverty level.
The ACA uses your modified adjusted gross income (MAGI) to determine savings. This is different from your adjusted gross income (AGI), which appears on your tax return. MAGI is not a number found on your tax return.
Additionally, your savings will be calculated from an estimated household income for the year in which you want health insurance coverage. A snapshot of qualifying income limits is shown in the chart below.
Household size | 100% of federal poverty level | 138% of federal poverty level | 400% of federal poverty level |
---|---|---|---|
1 | $15,060 | $20,783 | $60,240 |
2 | $20,440 | $28,207 | $81,760 |
3 | $25,820 | $35,632 | $103,280 |
4 | $31,200 | $43,056 | $124,800 |
5 | $36,580 | $50,480 | $146,320 |
Generally, if your household income is 100% to 400% of the federal poverty level, you will qualify for a premium tax credit. This means an eligible single person can earn from $15,060 to $60,240 in 2025 and qualify for the tax credit. (Tax credit information for the 2025 coverage year is based on 2024 federal poverty guidelines.) A family of three would qualify with income from $25,820 to $103,280 in 2025. The income range is $31,200 to $124,800 in 2025 for a family of four. (Income limits are higher in Alaska and Hawaii because the federal poverty level is higher in those states.)
The American Rescue Plan Act of 2021 also extended subsidy eligibility to some people earning more than 400% of the federal poverty level.
Other affordable health insurance options: Depending on your age, income, and medical history, you may be able to access other low-cost health insurance plans. Find out which ones you could qualify for.
What’s the right ACA plan for you? Your placement in the Affordable Care Act’s “metal tiers” is based on your income and determines how much you’ll pay. Read more about each of the tiers and what to know before picking a plan.
Understanding your essential benefits: All ACA plans must include coverage for certain essential medical services. Learn more about what falls under these essential benefits — and what’s not covered.
Heathcare.gov offers a calculator to help you determine whether you qualify for savings. The site also explains what kinds of income to include in your estimate.
If your income is below 138% of the federal poverty level, and you live in a state (or Washington, D.C.) that has expanded Medicaid coverage, you may qualify for Medicaid based solely on your income. The Affordable Care Act enrollment process will help you sign up for Medicaid in your state.
If your income is below 100% of the federal poverty level, you are probably not eligible for savings on an ACA plan or for Medicaid solely based on income. You may qualify for Medicaid based on disability, age, or certain conditions. You could enroll in the lowest-cost ACA plan, if you can afford to do so, or explore free or low-cost health insurance.
As mentioned earlier, MAGI is different from AGI. Your AGI is a number found on your tax return; it appears on line 11 of IRS Form 1040. MAGI is a modified figure and an estimate of your expected earnings in the coverage year. MAGI does not include Supplemental Security Income (SSI).
Income for your household includes information about you, your spouse, and everyone you'll claim as a tax dependent on your federal tax return (if the dependents are required to file). You should include their income even if they don’t need health coverage.
MAGI starts with your AGI, plus:
Untaxed or tax-exempt foreign income
Non-taxable Social Security benefits
Tax-exempt interest
Then, you’ll add information about these changes in income or life circumstances:
Anticipated raises
Income generated by new work or other employment changes, including self-employment income
Changes to other income, such as Social Security and investments
Household changes, such as gaining or losing dependents
Whether you add alimony depends; it’s added for separations and divorces finalized before January 1, 2019, but not on or after that date
Here’s a list of the types of income you should and should not include in your estimate:
Include | Do not include |
---|---|
Federal taxable wages from your job | Child support |
Tips | Gifts |
Self-employment income | Supplemental Security Income (SSI) |
Unemployment income | Veterans disability payments |
Social Security income | Workers’ compensation |
Social Security Disability Income (SSDI) | Proceeds from loans |
Retirement or pension income | Child tax credit checks or deposits from the IRS |
Investment income | |
Rental or royalty income |
The Affordable Care Act aims to make healthcare coverage more accessible in several ways:
Households with incomes from 100% to 400% of the federal poverty level receive subsidies that reduce their health insurance costs.
States have the option of expanding Medicaid to cover people with household incomes below 138% of the federal poverty level, or $43,056 for a family of four in 2025.
Consumers receive preventive care services without out-of-pocket costs.
Consumers who have pre-existing health conditions can receive coverage.
Young adults can remain on their parents' health insurance plans until at least age 26.
ACA health insurance plans also cover these 10 essential health benefits:
Emergency services
Hospitalization
Laboratory services
Mental health and substance use disorder services
Outpatient care
Pediatric services, including oral and vision care for children
Pregnancy, maternity, and newborn care
Prescription drugs
Preventive and wellness services
Rehabilitative services
The ACA provides savings for low-income and moderate-income individuals and families. Generally, the less money you make, the more financial help you will receive under the law.
Individuals and families earning 100% to 400% of the federal poverty level — and sometimes more — will qualify for savings on monthly premiums. What you pay each month also depends on the plan you select.
ACA plans are organized by ”metal” tiers: bronze, silver, gold, and platinum. Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs when you receive care. Platinum plans have the highest monthly costs but the lowest expenses when you access care.
More generous subsidies now fully cover the cost of a benchmark silver plan for consumers with incomes up to 150% of the federal poverty level. This same group also receives extra savings (which are only available when you are enrolled in a silver plan) that greatly reduce deductibles and copays to make what you pay when you access care similar to out-pocket costs with gold or platinum plans.
Subsidies are based on your estimated income in a coverage year, but your actual income could be higher or lower. If your earnings are less or more than expected, your premium tax credit could be adjusted. For example, if you earn more, you may have a higher tax bill because your subsidy was overestimated. To avoid this, make sure you report income changes throughout the year.
The ACA makes health insurance more affordable by:
Placing certain limits on what insurance providers can charge consumers. Insurers are prohibited from charging consumers higher premiums because they have pre-existing conditions such as cancer or diabetes.
Providing subsidies to low-income and moderate-income people to reduce their overall health insurance costs.
Ensuring that consumers covered by ACA health plans receive certain preventive health services — including wellness visits, mammograms, and other screenings, as well as some vaccinations — without out-of-pocket costs.
Offering additional cost-sharing reductions for people who qualify and choose a silver plan. These are “extra savings” on out-of-pocket expenses such as your deductible, copayments, and coinsurance.
Allowing states to expand their Medicaid programs to provide coverage to people with slightly higher incomes than previously qualified.
There are several ways to sign up:
Enroll online through Healthcare.gov.
Use the Find Local Help tool to locate in-person assistance in your area with a navigator or a health insurance agent and broker. All of them are trained to walk you through the marketplace process, and services are free.
Apply through the website of a certified enrollment partner, such as a private health insurance company.
Enroll by phone by contacting the Marketplace Call Center at 800-318-2596. This line is available 24 hours a day, 7 days a week — excluding holidays — with service in English and other languages.
Complete and mail in an application.
The Affordable Care Act offers health insurance options for people who don’t have access to job-based insurance and may not qualify for Medicaid. The ACA now offers most enrollees premium subsidies that reduce monthly healthcare costs. Initially, your premium tax credit will be based on your estimated income for the coverage year. Your actual income may be more or less than expected. If your income exceeds your estimate, this may result in a higher tax bill.
CMS.gov. (2024). Marketplace 2025 open enrollment fact sheet.
Healthcare.gov. (n.d.). How to estimate your expected income.
Healthcare.gov. (n.d.). Income levels & savings.
Healthcare.gov. (n.d.). Adjusted gross income (AGI).
Healthcare.gov. (n.d.). Affordable Care Act (ACA).
Healthcare.gov. (n.d.). Agent and broker (health insurance).
Healthcare.gov. (n.d.). Coinsurance.
Healthcare.gov. (n.d.). Copayment.
Healthcare.gov. (n.d.). Cost sharing.
Healthcare.gov. (n.d.). Count income & household size.
Healthcare.gov. (n.d.). Coverage for pre-existing conditions.
Healthcare.gov. (n.d.). Deductible.
Healthcare.gov. (n.d.). Federal poverty level (FPL).
Healthcare.gov. (n.d.). Getting covered if you’re under 30.
Healthcare.gov. (n.d.). Medicaid expansion & what it means for you.
Healthcare.gov. (n.d.). Modified adjusted gross income (MAGI).
Healthcare.gov. (n.d.). Navigator.
Healthcare.gov. (n.d.). Pre-existing condition.
Healthcare.gov. (n.d.). Preventive health services.
Healthcare.gov. (n.d.). Ways to apply for health insurance.
Healthcare.gov. (n.d.). What marketplace health insurance plans cover.
IRS. (2024). Adjusted gross income.
KFF. (2024). Explaining health care reform: Questions about health insurance subsidies.
Office of the Assistant Secretary for Planning and Evaluation. (2024). HHS poverty guidelines for 2024.