Be Aware of Advanced Premium Tax Credit Limits

In 2015 Nevada began using the Federal Health Insurance Marketplace.  This is the program that provides financial help to many Nevada residents by paying part of the health insurance cost every month.  The money received is called an Advanced Premium Tax Credit or APTC.

The Health Insurance Marketplace bases eligibility for Advanced Premium Tax Credits (APTC’s) on your income and family size. You will receive a smaller subsidy every month from the government the more your family makes. If you make less, then you will receive a larger subsidy. The government does have minimums and maximums you can earn in order to receive the credit, and those are listed below.

If you don’t fall into this threshold, don’t worry. These are just preliminary steps to determine where we should start looking for a plan.

Advanced Premium Tax Credit (APTC) Eligibility (2016)

Please use these guidelines for 2017 cost assistance

Number of People on Tax ReturnMedicaid Eligibility (138% of FPL)Premium Subsidy Threshold (400% of FPL)
1$16,394$47,520
2$22,108$64,080
3$27,821$80,640
4$33,534$97,200
5$39,247$113,760
6$44,960$130,320
7$56,428$146,920
8$61,335$163,560
First Example:

Adult making $30,000 per year – 1 person making 30K is well within the eligibility for an APTC ($16,243 to $47,080)

Second Example:

Family of 3 making $20,000 year total – Medicaid eligible – (below $27,725 threshold) It doesn’t matter if it’s a family with 2 adults and 1 child or 1 adult and 2 children or 3 adults… as long as they are all on one tax return.

Third Example:

2 person household earning $64,000 per yearPrivate Insurance / Non-Marketplace – (above $63,720 max) – In this example, this family should compare plans directly from each of the insurance companies. They can find better plan options and possibly better prices outside of the Health Insurance Marketplace.

Cost Sharing Reductions for the Health Insurance Marketplace

Beyond qualifying for an APTC, you may also qualify for specific insurance plans that increase your benefits when you see a doctor.

If your income falls within the Medicaid Eligibility and the Silver -72 CSR Cutoff, you will be generally best served by choosing a Silver plan on the Health Insurance Marketplace. The advantage here is that the amount you pay to go to the doctor will generally be less expensive on the Silver plan than the Gold, or Platinum plans (and at a much lower monthly payment than the Gold or Platinum plans).

Number of People on Tax ReturnMedicaid Eligibility (138% of FPL)94 CSR’s Cutoff (150% of FPL)87 CSR Cutoff (200% of FPL)72 CSR Cutoff (250% of FPL)
1$16,394$17,820$23,760$29,700
2$22,108$24,030$32,040$40,050
3$27,821$30,240$40,320$50,400
4$33,534$36,450$48,600$60,750
5$39,247$42,660$56,880$71,100
6$44,960$48,870$65,160$81,450
7$50,687$55,095$73,460$91,825
8$56,428$61,335$81,780$102,225
Example A:

Family of 5 earning $40,000: Any adults in the family would qualify for -97 tier CSR’s, making their insurance plan benefits some of the best offered. The children would generally qualify for either Medicaid or Nevada Checkup. Both Medicaid and Nevada Checkup are low cost / no cost to the member.

Example B:

Family of 3 earning $45,000: Both adults and children will qualify for -72 CSR’s, making the Silver plans an excellent choice.

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