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Financial help for health coverage

What’s available?

There are two types of government subsidies that lower the cost of health coverage for those who qualify:

  • The Advanced Premium Tax Credit (APTC)—the government pays a portion of your monthly insurance premium
  • Cost Sharing Reduction—each time you use health care services, the government helps pay a portion of your out-of-pocket costs

When you buy your health plan, applying for the subsidies will be part of the process.

Who is it for?

The subsidies are designed to assist people who don’t have access to affordable health insurance through their workplace but earn too much money to qualify for Medicaid.

Do I qualify for a government subsidy?

You may qualify for one or both types of subsidies. It depends on:

  • How your income compares to the federal poverty level
  • Your family size
  • Whether or not you have access to affordable health insurance from an employer or other source

There are other criteria, but the main factor is your income. Check the chart below for details.

  • If your income falls within the first range, you may qualify for a premium tax credit.
  • If your income fits into the second range, you may also qualify for the cost sharing.

While this is a government program, BCBSND service reps can help you determine your benefit amount, fill out the necessary government forms and apply for coverage.

Persons in household

Premium tax
credit income range* 

Cost sharing reduction
income range** 

1$12,880 – 51,520$17,774 – 32,200
2$17,420 – 69,680$24,040 – 43,550
3$21,960 – 87,840$30,305 – 54,900
4$26,500 – 106,000$36,570 – 66,250
5$31,040 – 124,160$42,835 – 77,600
$35,580 – 142,320$49,100 – 88,950
$40,120 – 160,480$55,365 – 100,300
$44,660 – 178,640$61,630 – 111,650

*If your income falls into this range, you may qualify for a premium tax credit.
**If your income falls in this range, you may also qualify for a cost-sharing reduction.

U.S. Health and Human Services 2021 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA
[https://aspe.hhs.gov/poverty-guidelines]

Two things to know about this government tax program:

  1. To make it easy, we’ve put together the chart above. But please note, since this is a federal program, the government could change the criteria at any time.
  2. If you get a government subsidy, you'll have to report it when you send in your taxes. When it's time to file your taxes, you'll get a 1095 form with all the necessary information.

What if my family or income changes during the year?

Your premium tax credit amount may change when your family or income status changes, including:

  • Increases or decreases in your household income
  • Marriage
  • Divorce
  • Birth or adoption of a child
  • Becoming eligible or ineligible for health insurance through an employer or government program

If you have BCBSND insurance when you have a life change, we can help you recalculate your benefit.

How do I get the premium tax credit or the cost-sharing reduction?

As you fill out your health plan application on BCBSND.com [NEED LINK], your answers may prompt a notification to finish the process with a BCBSND customer service rep. That person can help you:

  • Determine your eligibility
  • Choose and apply for a health plan that works with the premium tax credits
  • Complete your government application for the subsidies