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What does subsidy mean in health insurance?

“To sum it up…”

  • Subsidies are features of Obamacare that make insurance more affordable
  • Premium tax credits are subsidies to make premiums affordable
  • Cost reduction assistance is a subsidy to reduce expenses, copays, and cost shares
  • Medicaid and the CHIP are subsidized healthcare coverage
  • Marketplace and Medicare no-cost benefits subsidize health plans

A subsidy is a form of payment, benefit, or advantage that the beneficiary does not have to repay. Subsidy often goes to people or institutions in need, but the subsidy is also a way of providing an incentive.

In the US health care system, a subsidy is a vital part of the on-going efforts for improvement and fairness.

Subsidy in health care covers some important parts of the Nation’s health care system. The Obamacare Marketplace, Medicare, Medicaid, and the CHIP are subsidized healthcare systems.

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Private Firms and Competition


The Original Medicare is a federal program; the rest of the civilian healthcare systems use private firms to deliver medical services.

Within Obamacare, there are subsidized premiums and cost sharing reduction assistance. Comparison shopping is an excellent way to find the best value in health insurance. The subsidies are important for lowering prices.

Income Qualifies


The two popular subsidies on the Obama Marketplace are premium tax credits and costs sharing reduction assistance. The measuring standard is the federal poverty guideline figure.

Marketplace subsidy benefits can go to subscribers with incomes as much as 400 percent of the federal poverty line. In tax credits and costs sharing reduction assistance, the benefits go greater portions to the lower income group.

Those within 250 percent of the poverty guideline get a greater benefit than those near the top of the range.

Using Annual Family Income


The income amount for Marketplace subsidies is the annual family income. This figure includes every person accounted for in the tax filing. The figure does not include incomes that are not taxable such as Supplemental Security Income (SSI).

The government uses the annual family income figure for determining eligibility for Marketplace plans, Medicaid, costs reduction assistance, and premium tax credits.

Subsidies in the Obamacare Marketplace


The Affordable Care Act offers costs reductions and costs savings for subscribers including direct subsidies.

Based on income, subsidies include credits, out-of-pocket costs reduction, and deductibles. Obamacare offers the below-listed subsidies to qualified subscribers.

  • Advance Premium Tax Credits use income tax returns to advance funds against monthly premiums. These reduce the Monthly out of pocket expense for premiums by a significant amount. At the end of the tax year, the subscriber files a return and adjusts the credits
  • Costs-sharing reduction subsidies are part of the Obamacare Marketplace. Based on income, the eligible plans get costs reduction assistance in the form of lower copays and lower coinsurance. They also get lower maximum levels for deductibles and out-of-pocket expenses
  • Health Savings Accounts subsidize out of pocket costs and high deductibles with tax advantages savings
  • Small Business Tax Incentives provide deductions and credits for small businesses with 25 or fewer employees that offer health insurance to employees
  • Flexible Spending Accounts are funds put to the disposal of a subscriber to pay for medical expenses. Usually less than the deductible, these funds are useful in areas that have few choices for healthcare services.

Health Savings Accounts


The subsidy of a pretax savings plan is significant. HSA holders save on annual taxation and the gain financial benefits of tax-advantaged income earned on the deposits.

Health Savings Accounts are an underutilized part of Obamacare.It provides a vehicle for healthy young subscribers to develop a financial asset that covers health exigencies while taking advantage of tax laws.

In the long run, the HAS rolls into a tax-advantaged savings account with income derived from the passive investment.

Should the subscriber need to use the funds to pay a deductible expense, the insurance company will have to cover the essential items under coinsurance. When past the expense limits, the insurer covers 100 percent of the essential benefits.

The SHOP Incentives

The Affordable Care Act offers incentives for small businesses to get involved and add health insurance to protect their employees. SHOP or small business Health Options works for firms with 49 or fewer employees. The program is best for the small sized firms with fewer than 25 employees.

Max Tax Credits


The maximum amount of tax credits is fifty percent of the sum paid in for employee insurance. This maximum amount can go to small employers with 25 or fewer employees. It is a tax credit available for a period of years.

The credit can offset profits and by that reward the business owner with a useful credit during profit making years when the government would have taxed the business income. The employer can deduct the full amount of expenditures for employee health insurance. The employer can hold the tax credits for years when profits make it most useful.

Owners can Participate

Owners can participate in employee health insurance groups. Employers may lack health insurance. In the pre-ACA information, some reports suggested that about forty percent of small business owners were not insured.

Owners cannot participate in business insurance programs unless their employees not related by blood or marriage also participate. Joined by employees, owners can participate in the group insurance they sponsor for employees and likely save on the costs of their qualified health insurance.

Subsidies in Medicare


Medicare A and B make up the Original Medicare. Medicare prices reflect federal regulations and price setting for medical services. They amount to a substantial price subsidy. The Medicare prices are usually a fraction of fair market value for the services.

Original Medicare sets prices and medical services providers accept the assignment or bill for the excess. The bargaining power of the federal government and millions of subscribers is a powerful market force that yields a subsidy.

Medicare Advantage with Prescription Drug Benefit


The below-listed items are prescription subsidies for older Americans in the Medicare laws. These are powerful subsidies that make treatment by outpatient medications feasible for millions of patients.

The Donut Hole is an example of a subsidy. The Affordable Care Act provided funds and market reforms to eliminate the pricing support gap in the higher ranges of annual prescription spending. The Donut Hole will narrow each year and finally disappear in the fiscal year 2021.

  • Original Medicare with stand-alone Prescription benefit
  • Medicare Advantage with Prescription Drug Benefits
  • Medigap with Prescription drug benefit

Subsidies in Medicaid

Medicaid is an income-tested program. Participants must generally earn less than the federal poverty line amount per year on an annual family income basis. Medicaid is comprehensive health insurance coverage.

It offers protection for hospitalization, medical services, and institutional care. It works with other programs such as Medicare to cover insurance gaps, reduce customer costs sharing, and coinsurance.

Medicaid Expansion


The gap between the lowest amount for Marketplace coverage the highest amount for Medicaid eligibility is called the Medicaid Gap. The federal government offered to expand Medicare to 138 percent of the poverty line and cover most of those in between Obamacare and Medicaid.

Medicare Expansion could have covered many millions of American families. Most governors and state legislators decided not to accept. The choice went nearly exactly along political party lines.

Subsidies in the CHIP

The Children’s Health Insurance Program is subsidized insurance for children and minors in need. It is a state-run program with federal financial assistance. The program provides medical insurance, hospital care, vision and dental care.

Eligibility based on age and need, the CHIP serves millions of families nationwide. Fees can be low or no fee depending on need. The total subsidy defines the priority on children’s health and not on maximizing user contributions.

CHIP is a true subsidy; the funds or value of services don’t have to be repaid later.

Subsidy in Health Care


There are abundant amounts of subsidy in the US health care system. There are subsidies for the young (CHIP), the older citizens ( Medicare), and those in between with varying amounts of income( Marketplace and Medicaid). Subsidies also include the no-cost prevention services written into every qualified health plan by force of the Affordable Care Act.

Comparison shopping is a key for finding the best fit for Marketplace plans, Medicare Advantage, Prescription Drug benefits, and Medigap plans.

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  1. https://www.healthcare.gov/glossary/subsidized-coverage/
  2. https://www.healthcare.gov/glossary/original-medicare/
  3. https://www.healthcare.gov/lower-costs/save-on-monthly-premiums/
  4. https://www.healthcare.gov/glossary/modified-adjusted-gross-income-magi/
  5. http://obamacarefacts.com/whatis-obamacare/
  6. http://obamacarefacts.com/health-insurance/health-savings-account-hsa/
  7. http://obamacarefacts.com/insurance-exchange/shop-exchange/
  8. https://www.irs.gov/pub/irs-pdf/f8941.pdf
  9. http://obamacarefacts.com/benefitsofobamacare/
  10. http://obamacarefacts.com/medicare/what-is-medicare/
  11. http://obamacarefacts.com/medicare/medicare-advantage/
  12. https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
  13. https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/
  14. http://obamacarefacts.com/obamacare-chip-childrens-health-insurance-program/
  15. http://obamacarefacts.com/obamacare-subsidy-spending/