Marketplace subsidies, including premium tax credits and cost-sharing reductions, are calculated using the prior year's Federal Poverty Level Guidelines. The table below details the 2022 guidelines for the 48 contiguous states and D.C. The guidelines for Hawaii and Alaska are slightly higher, so use the links below the table for additional resources.

Status of State Action on the Medicaid Expansion Decision

State Health Insurance Marketplace types 2023,Marketplace types 2023,

Expanded and Enhanced Subsidies Through 2025

Expanded and enhanced marketplace premium subsidies, enacted under the American Rescue Plan Act (ARPA), took effect in 2021 and remain in effect for 2022. The recently passed Inflation Reduction Act (IRA) ensures that the ARPA’s subsidies continue without interruption for an additional three years, through 2025.

Just like the ARPA, the enhanced subsidies in the Inflation Reduction Act reduce costs across the board by further lowering payments for people who were already eligible for subsidies under the original ACA subsidy structure and by extending subsidy eligibility to middle-income people by removing the upper income limit on subsidies.

The subsidy now fully covers the cost of enrolling in the benchmark silver plan for consumers with income up to 150% of the federal poverty level (FPL). With the original ACA subsidy structure, consumers at 150% FPL ($20,385 for a single person in 2023, or $41,625 for a family of 4) had to pay about 4% of household income for the benchmark plan. By reducing premium contributions to $0 (or near $0), the Inflation Reduction Act essentially guarantees access to silver plans with generous cost sharing reductions that substantially reduce deductibles and copays.

The Inflation Reduction Act, like the ARPA before it, extends eligibility for premium tax credits to reach people with incomes over 400% FPL ($54,360 for a single person in 2023, or $111,000 for family of 4). Now these consumers must contribute no more than 8.5% of their income toward the benchmark silver plan. This change is especially beneficial to older marketplace consumers (50 and older) whose premiums are age-adjusted in most states and can be up to 3 times that of young adult premiums for the same policy. The average unsubsidized silver plan premium for a 60-year-old couple in 2023 is more than $1,900 per month in 2023. Under the original ACA subsidy structure, subsidies were unavailable to people with incomes above 400% FPL, meaning premiums for older enrollees could easily cost more than 20% of their household income. But now, premium payments are capped at no more than 8.5% of household income.

Source: Cynthia Cox, Karen Pollitz, Krutika Amin, and Jared Ortaliza, Nine Changes to Watch in ACA Open Enrollment 2023, (KFF, Oct 27, 2022) https://www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/ (10/30/2022).

Millions of people now eligible for marketplace subsidies

Until this year, an estimated 5.1 million people were ineligible for marketplace subsidies because of the family glitch. Generally, people are ineligible for marketplace subsidies if they have an offer of “affordable” job-based coverage – including through a family member’s job. However, until 2023, the affordability of job-based coverage for a worker’s spouse and dependents only measured the premium contribution required for the worker’s self-only coverage. As a result, if an employer coverage offer met the affordability threshold (9.12% of income in 2023) for self-only coverage but not for family coverage, those family members were nonetheless considered to have an offer of “affordable” job-based health coverage and locked out of ACA marketplace subsidies.

New rules will take effect for the 2023 coverage year, measuring the affordability of family coverage based on the worker’s premium contribution for family coverage. If that amount is more than 9.12% of household income in 2023, family members will have the option of buying health coverage through the Marketplace and will be eligible for premium tax credits based on their income.

Source: Cynthia Cox, Karen Pollitz, Krutika Amin, and Jared Ortaliza, Nine Changes to Watch in ACA Open Enrollment 2023, (KFF, Oct 27, 2022) https://www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/ (10/30/2022).

Marketplace rules have been relaxed for those who fell behind on premium payments

Until this year, an estimated 5.1 million people were ineligible for marketplace subsidies because of the family glitch. Generally, people are ineligible for marketplace subsidies if they have an offer of “affordable” job-based coverage – including through a family member’s job. However, until 2023, the affordability of job-based coverage for a worker’s spouse and dependents only measured the premium contribution required for the worker’s self-only coverage. As a result, if an employer coverage offer met the affordability threshold (9.12% of income in 2023) for self-only coverage but not for family coverage, those family members were nonetheless considered to have an offer of “affordable” job-based health coverage and locked out of ACA marketplace subsidies.

New rules will take effect for the 2023 coverage year, measuring the affordability of family coverage based on the worker’s premium contribution for family coverage. If that amount is more than 9.12% of household income in 2023, family members will have the option of buying health coverage through the Marketplace and will be eligible for premium tax credits based on their income.

Pre-enrollment verification eliminated except for SEPs due to loss of other coverageOnce Open Enrollment ends, people will continue to be able to sign up for Marketplace coverage mid-year if they have a qualifying life event (such as loss of other coverage, marriage or divorce, or a permanent move) using a 60-day special enrollment period (SEP). In HealthCare.gov states, people had been required to first complete a pre-enrollment verification process by providing documentation of their qualifying event that made them eligible for an SEP. People who could not provide such documentation within 30 days often were denied the SEP.

Starting in 2023, HealthCare.gov will only require pre-enrollment verification for SEPs due to loss of other prior coverage. For other qualifying events (marriage, divorce, permanent move, etc.) people will be able to self-attest to their eligibility and proceed to enroll in coverage during their SEP.

Source: Cynthia Cox, Karen Pollitz, Krutika Amin, and Jared Ortaliza, Nine Changes to Watch in ACA Open Enrollment 2023, (KFF, Oct 27, 2022) https://www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/ (10/30/2022).