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How Do I Know if I’m Eligible for a Health Insurance Subsidy?

Health Insurance Subsidy Information

When the Affordable Care Act began to take effect in 2010, it brought many changes to the landscape of healthcare in the United States. Perhaps the largest change among those was the mandate that requires all US citizens (with a few exceptions) to have health insurance.

Though many people receive health insurance coverage for themselves and their family through their employer, there are many citizens out there who may not have equally convenient access to insurance. Prior to the ACA, those individuals were able to elect whether or not they wanted to purchase health insurance. Now, due to the health insurance mandate, everyone must be covered in some way.

However, those who do not receive assistance from an employer or who are unable to afford insurance on their own are not without options. The federal government may offer subsidies to these individuals and families.

What is a Health Insurance Subsidy?

A health insurance subsidy is provided through the federal government to offer assistance to customers who need insurance, and who fall within a particular income bracket. Unlike a loan, most subsidies do not have to be repaid, although income or qualifying life events could impact receipt or payment of said subsidies.

There are two kinds of subsidies available. The Advanced Premium Tax Credit lowers the monthly health insurance premium, while the Cost Sharing Reduction subsidy reduces any out-of-pocket costs you pay during a policy period, including your deductible, coinsurance and copays, which all add up to your out-of-pocket maximum.

How Do I Know if I’m Eligible for a Health Insurance Subsidy?

Eligibility for a health insurance subsidy depends on a number of factors. First, your annual income will be compared to the federal poverty level. Second, the size of your family may help determine eligibility and, lastly, health insurance prices where you live will also matter.

A variety of factors will determine whether or not you are eligible for one, or both, federal subsidies. Though other factors are assessed, income level is the most important determining factor. Blue Cross Blue Shield has a great Subsidy Estimator that will help you determine your eligibility in a matter of minutes. Check out their estimator here.

Health Insurance Agents Cary, NC

Here at the Wooten Agency in Cary, NC we are happy to help all of our clients, and potential clients, when it comes to choosing the health insurance that’s right for them. If you have questions about subsidy eligibility or health insurance prices in North Carolina, give us a call today or request a free consultation here. We are more than happy to guide you in the right direction!


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Regardless of whether you purchase a policy or not, we are always happy to help in any way we can.

Client Testimonials

Health Insurance Subsidy Eligibility Rules | Health Insurance NC

  • "This is a family-owned business who cares about their potential clients. I was looking for help with health insurance and even though it turns out I don't need new health insurance at this time, I feel compelled to write a review because of how thorough Brendan was. He was very knowledgeable and easy-going. He didn't seem pushy at all and listened to everything I had to say. He made sure he was getting all the information correct. I would recommend this agency for any insurance needs." - Doug C.
  • "I sought help from Wooten Agency; Ed, along with Nancy, took the bull by the horns and sorted things out for us very quickly. Shortly thereafter Ginny took over. She is definitely most qualified as a plan selector for Medicare plans and issues related to Medicare. My appreciation to Crystal for the gracious way she always responds to telephone calls and makes every effort to ensure one is not forgotten. And Dana....the one contact we had was enough to find out you are similarly inclined to help a client." - Frank V.
  • "You [Aaron] have been so helpful, and you have all taken a personal interest in my individual and specific questions in order to make the best insurance choices for my needs. Thank you all! I look forward to working together in the future months and years." - Susan H.
Wooten Agency