The biggest barrier to obtaining comprehensive health care coverage is affordability for many of the United States’ 48.6 million uninsured individuals.

Nearly  half of the uninsured with heart disease or stroke cite cost as the reason they lack coverage. Soaring premium and out-of-pocket costs have kept quality health insurance out of reach for many, particularly for Americans with low-to-moderate incomes and families whose employers do not offer a health plan.

One of the key provisions of the Affordable Care Act — the Health Insurance Premium Tax Credit – will help address this obstacle to acquiring health insurance. Anyone without access to affordable employer-sponsored insurance may be eligible to receive this new type of tax credit when they purchase coverage through the Health Insurance Marketplace.

Plans presented through  the Marketplace must offer “essential health benefits” in at least 10 categories, such as hospital care, doctors’ office visits, prescription drugs and preventive care.  By utilizing the tax credits, uninsured individuals and families — including those suffering from heart disease and stroke — can obtain affordable  comprehensive health insurance coverage.

It is estimated that 90 percent of Americans  who are currently uninsured will qualify for the credit.

To be eligible: 

  • Your annual income must fall below  400 percent of the federal poverty level, which translates to about $46,000 for an individual, $62,000 for a couple, $78,000 for a family of three and $94,000 for a family of four;
  • You can’t qualify for adequate, affordable coverage through an employer or government plan, such as Medicare;
  • You must purchase health insurance through the Marketplace.

The size of the tax credit depends on income and family size. However, no family qualifying for a tax credit will have to pay more than 9.5 percent of their income on health insurance premiums. Lower-income families will pay the least and those with the lowest incomes may be eligible for a health plan with no premiums at all.

 The Premium Tax Credit also gives other options. If you qualify, you can choose to take the credit right away and pay a lower health insurance premium each month. For example, a person who qualifies for a $50-per-month tax credit and chooses a health plan with a $150 monthly premium would only pay $100-per-month for coverage.

If you decide to take the credit later, you will pay the full monthly premium. You may then later subtract your tax credit on your federal tax return, lowering your tax bill or increasing your refund.

Eligibility for the tax credit will be determined annually prior to the open enrollment period. Anyone who wants coverage to start on Jan. 1 needs to sign up through the Health Insurance Marketplace by Dec. 15 at

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 Photo courtesy of Maggie Francis