- Age and geographic region
- Household income and size, and
- The cost of affordable healthcare coverage in your geographic region
Age and geographic region
Income, household size and affordable coverage
Effective March 2023
Annual Income2 | ||||
---|---|---|---|---|
Household size1 | 400% of FPL and above | 300% of FPL | 200% of FPL | Up to 150% of FPL |
Individual | $54,360 | $40,770 | $27,180 | $0 - $20,385 |
Couple/2 people | $73,240 | $54,930 | $36,620 | $0 - $27,465 |
Family of 4 | $111,000 | $83,250 | $55,500 | $0 - $41,625 |
Premium contribution level3 | Up to 8.5% of income | Up to 6% of income | Up to 2% of income | $1/month |
1 Based on number of people reported on your tax return
2 Based on Modified Adjusted Gross Income (MAGI)
3 How much you’re expected to contribute toward premium cost should not exceed this limit.
To calculate subsidy eligibility and amount, Covered California uses the second-lowest cost Silver (SLS) plan in your region, across all carriers, as the benchmark plan for “affordable coverage”. If the premium for the SLS benchmark plan exceeds your premium contribution limit for your income level, you may qualify for premium help because the benchmark plan is considered “not affordable”. This does not mean you are required to purchase the second-lowest cost Silver plan in your region. It’s just used as a benchmark for determining affordable coverage and available subsidy amount. You can use your subsidy to purchase any metal tier plan that fits your needs.
Example A: Erin and Francis
Ages: 62
Region: Live in a higher-cost region
Annual Income: $77,817
FPL: 425%
Expected contribution toward premium cost: 8.5% of income
Affordable Care Act baseline |
Expanded federally |
|
---|---|---|
Monthly Premium (SLS benchmark) | $2,414 | $2,414 |
Federal Premium Subsidy (Advanced Premium Tax Credit) | $0 not eligible because above 400% FPL | $1,863 |
Net Premium | $2,414 | $551 |
Net Premium Income Share | 37.2% | 8.5% |
Example B: Jones Family
Ages: 40, 45, 12, and 18
Region: Live in a lower-cost region
Annual Income: $166,500
FPL: 600%
Expected contribution toward premium cost: 8.5% of income
Affordable Care Act baseline |
Expanded federally |
|
---|---|---|
Monthly Premium (SLS benchmark) | $1,316 | $1,316 |
Federal Premium Subsidy (Advanced Premium Tax Credit) | $0 not eligible because above 400% FPL | $137 |
Net Premium | $1,316 | $1,179 |
Net Premium Income Share | 9.49% | 8.5% |
Source: Program Eligibility by Federal Poverty Level for 2023 (PDF, 263 KB)
1Based on number of people reported on your tax return