ACA Subsidies

Advanced Premium Tax Credits (APTCs): These tax credits can be applied directly to your monthly premium, reducing the amount you pay. The size of the tax credit depends on your income relative to the FPL, the cost of plans in your area, and your family size. The goal is to ensure that you do not spend more than a set percentage of your income on health insurance. As your income goes up, the amount of subsidy you're eligible for decreases.

Cost-Sharing Reductions (CSRs): CSRs are available for individuals and families with incomes between 100% and 250% of the FPL who choose Silver plans through the Marketplace. These subsidies reduce out-of-pocket costs such as deductibles, copayments, and coinsurance, making it more affordable to access healthcare services.

Medicaid

Medicaid is a joint federal and state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid eligibility and benefits can vary significantly from one state to another, especially since some states have expanded their Medicaid programs under the ACA.

Medicaid Expansion: Under the ACA, states have the option to expand Medicaid coverage to nearly all adults with incomes up to 138% of the FPL. The federal government covers a significant portion of the costs for individuals covered under Medicaid expansion. In expansion states, more low-income adults qualify for Medicaid.

Subsidy Rates: For Medicaid, there are no "subsidy rates" like there are for private insurance through the ACA; instead, eligible individuals and families receive full coverage or very low-cost coverage based on state-specific Medicaid guidelines. The federal government provides a matching rate (Federal Medical Assistance Percentage, or FMAP) to states, which varies based on the state's average per capita income.