Your Guide to the Federal Poverty Level – Income Limits to Qualify for ACA Subsidies

Sarah Sullivan
October 15th, 2019 October 15th, 2019 |
Read time: 8 minutes

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First off, why should you care about the federal poverty level (FPL)?

Because subsidies for ACA health insurance, both tax credits, and cost-sharing reductions, are based on your modified adjusted gross income (MAGI) relative to the federal poverty guidelines.

Did I lose you?

If so, don’t worry!

If you’re trying to figure out whether or not you qualify for a subsidy for health insurance, you can use our Affordable Care Act (ACA) subsidy calculator to get that information, as well as next steps depending on whether or not you qualify.

Do You Qualify for an Affordable Care Act Subsidy?

Use the ACA Subsidy Calculator to find out if you can get financial help if you enroll in ACA-qualifying major medical insurance. Learn more about subsidies.

If you do want to get a deeper understanding of the FPL, we’ve got you covered.

In the remainder of this blog post, we’ll discuss:

  • What exactly are the federal poverty guidelines and who sets them?
  • How does the federal poverty level factor when determining your subsidy amount?
  • 400% FPL, 200% FPL, and 100% FPL and why they’re important.
  • Two ways to determine your % FPL: using your income to calculate your % FPL, and viewing a quick reference chart for minimum qualifying income limits.
  • Non-ACA health insurance options if you don’t qualify for a subsidy and unsubsidized premiums are unaffordable.

The Basics of the Federal Poverty Level and Qualifying for ACA Subsidies

What is the federal poverty level? (Definition)

The federal poverty level (also referred to as “federal poverty guidelines”1) is one measure of poverty within the United States.

These guidelines are released annually by the U.S. Department of Health and Human Services (HHS) and are used to determine financial eligibility for federal programs and benefits, including:

The federal poverty guidelines are established for and apply to the 48 contiguous states and the District of Columbia. Alaska and Hawaii each have their own set of poverty guidelines.3

What About the “Federal Poverty Line” and “Poverty Thresholds?”
Is the FPL the same as the federal “poverty line”? Yes. The “poverty line” is just another commonly used (but less preferred) way of referring to the federal poverty guidelines/federal poverty level.4

Is the FPL the same thing as “poverty thresholds?” No. However, while they’re not interchangeable terms, they both refer to ways poverty is measured in the United States.

  • Federal poverty guidelines are issued by Health and Human Services (HHS) and serve an administrative function like determining financial eligibility for federal programs and benefits such as ACA subsidies.
  • Poverty thresholds are issued by the U.S. Census Bureau for statistical purposes.5

Learn more about the differences between poverty guidelines and poverty thresholds at aspe.hhs.gov.

2019 Federal Poverty Level

As previously mentioned, the FPL and your “modified adjusted gross income” or “MAGI”, relative to it is what determines your eligibility for ACA subsidies.

The federal poverty guidelines are on a one year lag when it comes to determining ACA (also referred to as Obamacare) health coverage subsidies. So when the “2019” FPL is referenced, that’s going to determine subsidies for Obamacare 2020 plan year health insurance, 2020 FPL will determine Obamacare 2021 plan year subsidies and so on.

2019 Federal Poverty Level –  Annual Household Income6

Number of People in Household 48 Contiguous + D.C. Alaska Hawaii
1 $12,490 $15,600 $14,380
2 $16,910 $21,130 $19,460
3 $21,330 $26,660 $24,540
4 $25,750 $32,190 $29,620
More than 4 +$4,420 per person +$5,530 per person +$5,080 per person

How do you use the numbers in the table above? You calculate your % of FPL using your MAGI and the income level associated with the size of your household.

Percent of the Federal Poverty Level Formula
Income ÷ Poverty Guideline based on Household Size = % of FPL

If you prefer to skip the math, you can jump right to the income limits chart (below) to see if your income level qualifies you for one or both ACA subsidy.

Let’s look at a couple of examples to get a better understanding of how to calculate your percent of the FPL.

How to calculate your percentage of FPL (generally)

To generally calculate where you fall in terms of percentage of FPL you’ll follow these steps:

  1. Find the annual income threshold that corresponds with the number of people in your household from the table above.
  2. Divide your modified adjusted gross income (MAGI) by the number from the table.
  3. Carry the decimal two places in your result.
  4. Add a percentage sign, and you have your answer.

Example 1: You are a single individual residing in Iowa with a MAGI of $25,000. The 2019 annual poverty level for a one-person household is $12,490.7

  1. Divide: $25,000 ÷ $12,490 = 2.0016
  2. Move the Decimal Point: 2.00 x 100 = 200
  3. Rounding up, you’re at 200% of the federal poverty guidelines and may qualify for a premium tax credit in 2020. You could qualify for a cost-sharing subsidy as well if you purchase a silver plan.

Example 2: You are married with three kids living in Illinois, and your household’s MAGI is $150,000. The 2019 poverty level for a five-person family or household is $30,170.8

  1. Divide: $150,000 ÷ $30,170 = 4.97
  2. Move the Decimal Point: 4.97 x 100 = 497
  3. Rounding up, you’re at 497% of the federal poverty guidelines and are unlikely to qualify for a subsidy.

These are general estimates (especially if you’re just using a rough AGI estimate in your calculations). Your actual subsidy amount will be determined when you apply for coverage through HealthCare.gov or your state-based health insurance exchange.

What is MAGI?
MAGI is used to determine your eligibility for certain federal tax benefits, including federal subsidies for ACA health insurance, however, you won’t find this number as a value on your tax return.9

In order to understand MAGI, it helps to understand AGI (“adjusted gross income”).

AGI is the total amount of income you made in a year minus certain deductions (and this value is a line item on your tax return).10

So to calculate your MAGI, add back to your AGI any of the relevant deductions that you took.11

If your taxes are relatively simple, your AGI and MAGI may be very similar or even identical12 so you may be able to get away with just using your AGI to get a rough idea of whether or not you could qualify for a subsidy. Learn more about MAGI at irs.com.

Please note, the materials available at this website are for informational purposes only and not for the purpose of providing legal or tax advice. You should contact your attorney or tax professional to obtain advice with respect to any particular issue or problem.

ACA subsidies you’re eligible for based on your percent FPL

Health insurance subsidies and eligibility for other public health insurance are determined based on a percentage of FPL as follows:

Percent FPL Subsidy or Program Eligibility
100 to 400% FPL13 ACA Premium tax credits if you enroll in any metal level plan from the ACA Marketplace
100 to 250% FPL14 ACA Cost-sharing reductions if you enroll in a Silver metal level health plan from the ACA Marketplace
Below 138% FPL15 If you’re in a state that expanded Medicaid, you qualify for Medicaid
Below 100% FPL16 If you’re in a state that did not expand Medicaid, you qualify for Medicaid

If your income does not qualify you for a subsidy and you’re considering going without coverage, consider a lower-premium non-ACA policy like short term health insurance instead.

These plans cover few, if any, essential health benefits, and typically do not cover preventive care or pre-existing conditions. They’re not guaranteed-issue like ACA plans are, so you’ll have to qualify in order to enroll.

Compare short term medical costs and benefits.

Get a Quote – Short Term Health Insurance

400% FPL and Medicaid Expansion

As you can see from the table above if your MAGI is at 400% or less of the FPL you qualify for a subsidy if you purchase health insurance at the ACA Marketplace…

That is, until you get to between 100% and 138% of FPL (depending on your state), at which point, your income is low enough that you may qualify for Medicaid (HHS.gov).17

You qualify at 138% if you live in a state that expanded Medicaid as part of the ACA and at 100% if you live in a state that did not expand Medicaid.

Find out if your state expanded Medicaid.18

What is Considered Low Income When Enrolling in the ACA?

If you don’t want to take on a mathematical story problem to find out what your % FPL is you can also use the minimum income limits quick reference chart below.

Obamacare Income Limits 2019

Locate the number of people in your household and see if your income could qualify for one or both of the ACA federal subsidies:

  • Blue = You could qualify for a premium tax credit (enroll in any ACA metal level plan through an ACA public Exchange).
  • Green = You could qualify for a premium tax credit and cost-sharing reduction (if you enroll in a Silver metal level health plan through an ACA public Exchange).

Minimum Income Limits to Qualify for 2020 ACA Subsidies
(48 Contiguous States + D.C.)19

Number of People in Household

% FPL 1 2 3 4 5 6
100% $12,490 $16,910 $21,330 $25,750 $30,170 $34,590
133% $16,612 $22,490 $28,369 $34,248 $40,126 $46,005
138% $17,236 $23,336 $29,435 $35,535 $41,635 $47,734
150% $18,735 $25,365 $31,995 $38,625 $45,255 $51,885
200% $24,980 $33,820 $42,660 $51,500 $60,340 $69,180
250% $31,225 $42,275 $53,325 $64,375 $75,425 $86,475
300% $37,470 $50,730 $63,990 $77,250 $90,510 $103,770
400% $49,960 $67,640 $85,320 $103,000 $120,680 $138,360

See 2019 FPL Charts for Alaska and Hawaii

Additional percentage breakouts are included in the chart above since other federal programs use different percentages to determine eligibility, such as 200% FPL.

If your income is higher than the minimum income limits included on the table, you likely will not qualify for a subsidy and will have to pay fully for your health insurance. If your income is lower, you may qualify for Medicaid.

If unsubsidized ACA insurance premiums are unaffordable, you may want to consider a non-ACA insurance option with a lower premium and less coverage rather than going without any health insurance.

Non-ACA Health Insurance: Short Term Medical

Short term health insurance is one non-ACA option that could provide you coverage for unexpected illnesses or injuries for 30 to 364 days depending on your state (or possibly up to 36 months depending on the policy renewal rules in your state).20

Plans typically provide benefits for hospital room and board; emergency room, anesthesiology and surgical care; diagnostic services (x-rays, lab tests and analysis); ambulance and surgical services; doctor office visits.

Some benefits of short term medical plans include:

  • Monthly premiums are 31.5% less than unsubsidized major medical insurance premiums on average, $124 per month compared to $393 (2016).21
  • There’s no open enrollment period so you can apply year-round in most states.
  • Plans are highly customizable so you don’t have to pay for coverage you don’t need.
  • No provider network limitations mean you can visit your preferred healthcare provider.

Some drawbacks of short term medical plans include:

  • They are not guaranteed-issue, you must be approved by the carrier in order to enroll.
  • They are not considered minimum essential coverage and have less coverage than major medical plans.
  • Pre-existing conditions are not covered.

See if a short term medical plan is available for you and start comparing costs and coverage.

Get a Short Term Medical Quote

Summary + Next Steps

You don’t need to know calculus to figure out if you qualify for a federal premium tax credit and possibly a cost-sharing reduction if you purchase ACA-qualifying health insurance from the federal Marketplace or your state Exchange.

Just use our ACA subsidy calculator.

If you don’t qualify for a subsidy and ACA premiums are unaffordable, don’t go uninsured.

Instead, consider applying for a non-ACA health policy like short term medical insurance to help cover some of your medical costs. Get a quote to find out if plans are available in your area and compare costs.

If you need one-on-one help determining your subsidy eligibility and health insurance options, work with a licensed agent. Call us at 888-855-6837, or find an agent near you.

Need Supplemental or Short Term Insurance?

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  • Compare multiple plans
  • Finish application online
Originally Published On February 22nd, 2013
Independence American Insurance Company and/or Madison National Life Insurance Company, Inc. may underwrite the products referenced on this website. Legal Disclaimers.

Footnotes

Get Health Insurance for 2020

Open enrollment is Nov. 1 to Dec. 15, 2019 in most states. Find out if you could qualify for an ACA subsidy.

 

ACA Subsidy Calculator

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