Financial Help with Pennie Health Insurance Subsidies
What are health insurance subsidies?
Health insurance subsidies are financial assistance programs established under the Affordable Care Act (ACA) to help lower the cost of health coverage for eligible individuals and families. By making health insurance more affordable, these subsidies ensure that more people have access to the care they need.
What is Pennie?
Pennie®, the Pennsylvania health insurance marketplace, offers you a choice of qualified health plans. You can purchase medical and dental plans through Pennie and see if you qualify for subsidies that can lower costs.
How do I know if I qualify for a health insurance subsidy as a Pennsylvania resident?
If you’re a Pennsylvania resident without health coverage through an employer and not eligible for Medicare or Medicaid, Pennie may have options for you. Through Pennie, you could qualify for valuable financial assistance established by the ACA to help make health coverage more affordable.
You may qualify for advanced premium tax credits (APTC) or lower your out-of-pocket costs with cost-sharing reductions (CSR). Your household income, where you live, and household size also determine if you are eligible for a tax credit. The chart below will help you determine if you qualify.
Advanced Premium Tax Credit (APTC)
This subsidy reduces your monthly insurance premiums. The amount you receive and if you are eligible for a tax credit depend on factors such as the cost of health coverage in Pennsylvania, your household income, where you live, and household size, which includes you, your spouse, and any tax dependents.
Cost-Sharing Reductions (CSRs)
This subsidy provides additional savings, which will lower out-of-pocket costs that you pay at the time of service for covered services like deductibles, coinsurance, copays, and the maximum amount you might pay out of pocket. To qualify for CSR, you must enroll in a Silver plan on Pennie.
You might even qualify for both tax subsidies, which can significantly reduce your health insurance costs throughout the year. You can view the products we offer or go directly to Pennie to see if you qualify.
What are the current Pennie income guidelines?
This chart, which shows the Federal Poverty Level Guidelines, can help you determine if you are eligible for a tax credit through the Pennie marketplace.
Federal Poverty Level guidelines1
Who needs coverage? |
What is the income for those covered under the health plan?(income % of Federal Poverty Level) |
||||
|---|---|---|---|---|---|
Family Size |
100% |
138% |
150% |
200% |
400% |
| Single | $15,060 | $20,738 | $22,590 | $30,120 | $60,240 |
| Family of 2 | $20,440 | $28,207 | $30,660 | $40,880 | $81,760 |
| Family of 3 | $25,820 | $35,632 | $38,730 | $51,640 | $103,280 |
| Family of 4 | $31,200 | $43,056 | $46,800 | $62,400 | $124,800 |
| Family of 5 | $36,580 | $50,480 | $54,870 | $73,160 | $146,320 |
| Family of 6 | $41,960 | $57,905 | $62,940 | $83,920 | $167,840 |
| Family of 7 | $47,340 | $65,329 | $71,010 | $94,680 | $189,360 |
| Family of 8 | $52,720 | $72,754 | $79,080 | $105,440 | $210,880 |
*This chart was last updated in 2024.
How does the tax credit work for Pennie?
When you apply for coverage through Pennie, you'll estimate your annual income and household details. If you qualify, the APTC can be applied upfront to lower your monthly premiums or claimed when you file your federal taxes. The amount of APTC you receive is determined by Pennie using factors such as your income, age, and the cost of the second-lowest-cost Silver plan available in your area.
It's important to note that if you use more APTC than you qualify for, you'll need to repay the difference when you file your taxes. The repayment amount is based on your final income, with lower-income individuals generally owing less.
Conversely, if you use less APTC than you qualify for, you'll receive the remaining amount as a refundable credit at tax time.
The APTC can be applied to any health plan, regardless of the metal category. To assist with tax filing, Pennie provides Form 1095-A, which you can use to complete Part II of Form 8962 and reconcile your premium tax credit.
What if I don’t qualify for health insurance savings through Pennie?
You can purchase your individual or family health insurance coverage direct from Capital Blue Cross. If you are not eligible for subsidies through Pennie, consider additional plan choices by viewing the products we offer.
1Pennie will reference the 2024 poverty level guidelines during the fall 2024 open enrollment period to determine eligibility for 2025 premium tax credits and cost-sharing reductions. Source: CMS.gov.
2For families/households with more than 8 persons, add $5,380 for each additional person.