Depending on how much you earn, you could get financial help with the cost of insurance. There are three ways to get financial help through Washington
Lower Costs on Monthly Premiums
Tax credits help lower the cost of your health insurance premium payments each month. Tax credit amounts are based on your income and are set by the federal government.
You’re eligible for tax credits if you:
- Buy health insurance through Washington Healthplanfinder
- Are within certain income limits
- Don’t have access to other insurance options through work or another government program
- Are a U.S. citizen or legal resident
- Don’t file a tax return as married filing separately
If you’re eligible for tax credits, you can choose to use some or all of your tax credit to lower your monthly premium payment, or wait to get all of your tax credit when you file your federal income tax return. You can change the amount of tax credits you use monthly through your Washington Healthplanfinder account.
Washington Healthplanfinder has developed a tool to help you estimate your premium tax credit. If your household income changes during the year providing an estimate of the changes to the premium tax credit amount. This tool does not calculate the actual premium tax credit, your eligibility to receive the tax credit, or provide legal, tax or accounting advice.
Lower Costs at the Doctor’s Office
Through Washington Healthplanfinder, you may be able to lower the costs you pay when you get health care. This is called cost-sharing reductions and means you could pay less for things such as doctor’s visits, lab tests, and drugs. Whether you qualify for lower costs depends on your income and family size. The lower your income, the more cost savings you can get.
To qualify for lower costs at the doctor’s office, your income must be below 250% of the federal poverty level, and you must choose a Silver plan. American Indians and Alaska Natives can also qualify to get these cost-sharing reductions when they enroll in a Bronze or Gold plan.
There are several different levels or “tiers” of cost-sharing for health plans
Most tiers are related to your income, and others are tied to specific benefits for American Indian/Alaska Natives.
- Tier 1 is the standard, full-cost health plan which pays 70% of the costs
- Tier 2 provides a discount for American Indian/Alaska Natives with lower incomes (under 300% of the federal poverty level)
- Tier 3 provides a discount for American Indian/Alaska Natives above 300% federal poverty level or who are not applying for tax credits
- Tier 4 is the lowest discount, where the health plan covers 73% of the costs*
- Tier 5 is the middle discount, where the health plan covers 87% of the costs*
- Tier 6 is the biggest discount, where the health plan covers 94% of the costs*
*This cost-sharing is only available when you chose a silver metal level health plan.
If you qualify for cost-sharing reductions and you have a change of income during the year, your discount may change or even make you ineligible for cost-sharing reductions, depending on your new income level.
Individuals with lower incomes may qualify for free coverage, called Washington Apple Health (Medicaid). If you’re eligible for Washington Apple Health, you’ll be given the option to choose a managed care plan that’s available in your area. Customers can sign up for Washington Apple Health year-round.