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How Household Size and Income Affect Marketplace Insurance

Navigate health insurance wisely: Household size & income matter! Dive into how they shape your marketplace coverage, subsidies, and costs.

Household size and income affecting marketplace insurance
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When it comes to health insurance, there are a lot of factors that affect how much you pay. One of those factors is the size of your household. This includes the people who live with you and any tax dependents you have. It’s important to include everyone in your household when you’re applying for coverage, it is one of the things that determines your subsidy amount.

Your income is another important factor when it comes to marketplace insurance. The amount of money you make affects how much of a subsidy you may qualify for, as well as whether or not you have to pay the penalty for not having health insurance. If your income is above a certain threshold, you may not be eligible for a subsidy at all.

There are other factors that can affect your premium, such as your age, tobacco use, and where you live. But household size and income are two of the most important factors to keep in mind when you’re shopping for marketplace insurance. Keep these things in mind as you compare plans, and you’ll be on your way to finding the right coverage for you and your family.

What income counts a health insurance marketplace plan?

The Affordable Care Act (ACA) was passed by the United States government to assist families with health coverage expenses. The federal government uses your modified adjusted gross income (MAGI) to determine whether you’re allowed to enroll in subsidies. This is basically your total household income from all sources, minus any deductions or adjustments. So if you’re single and have a MAGI of $48,560, you would qualify for savings through subsidies. But if your MAGI is $51,040, you would not qualify. Most people qualify for health coverage services through the federal government.

Your MAGI income source includes:

  • Wages, salaries, and tips
  • Interest and dividends
  • Self-employment income
  • Capital gains and investments
  • Business or farm income
  • Retirement and pension distributions
  • Rental and royalty income
  • Unemployment compensation
  • Alimony payments
  • Child support payments
  • Social security benefits
  • foreign income
  • Other taxable income

Your MAGI income does not include:

  • Non-taxable interest
  • HSA or MSA distributions
  • Tax-exempt interest
  • Untaxed Social Security benefits
  • Child support payments not included in your MAGI
  • Adoption assistance
  • Energy assistance payments
  • retirement savings
  • If you file a joint return, both spouses’
  • HSA, FSA, or MSA contributions
  • If you’re not sure what your MAGI is, you can use the IRS tool to help you calculate it.

How household size affects your subsidy

Your household size is important because it’s one of the things that determines your subsidy amount as provided by the United States Government through tax credits. The larger your household, the higher your subsidy will be. That’s because subsidies are based on a percentage of your poverty level, and poverty levels are higher for larger households. So if you have a household of four, you would get a bigger subsidy than someone with a household of two.

To see how this works, for families of four with a household income of $50,000. Your poverty level would be $27,750, and your subsidy would be $13,875(which is 50% of your poverty level). But if you’re a single person with no children and a household income of $50,000, your poverty level would be $13,590, and your subsidy would be only $6,795(which is 50% of your poverty level).

Keep in mind that subsidies are only available to people who purchase their insurance through the marketplace. If you have employer-sponsored insurance or get your insurance some other way, you won’t be able to enroll in a subsidy.

How income affects your premium

Income is also a factor when it comes to how much you pay for your premium. If your income is below 400% of the poverty level, you’ll qualify for cost-sharing reductions. This means that you’ll have to pay less for your deductible, coinsurance, and copayments.

If your income is above 400% of the poverty level, you won’t be eligible for cost-sharing reductions. But you may still be eligible for a premium tax credit, which is a subsidy that helps you pay for your monthly premium. The amount of the credit is based on your income and is

Who is included in the household?

For the purposes of the health insurance marketplace, your household members includes:


Your spouse (if you’re married)

Your children (including unborn children who are expected to be born during the coverage year)

Your tax dependents (including parents, grandparents, foster children, and any other adults who you claim as a dependent on your taxes)

If you have any other relatives who live with you and rely on you for financial support, they may also be included in your household. But this is determined on a case-by-case basis.

How to best estimate your expected income?

If you’re not sure what your income will be for the year, you can estimate it. The best way to do this is to look at your tax return from the previous year. If your income has changed significantly since then, you can use an estimate of what you think it will be for the current year. Keep in mind that if you end up making more income than you estimated, you may have to pay back some of your subsidy. But if you make less income than you estimated, you’ll get a bigger subsidy.

What if my income changes during the year?

If your income changes during the year, it’s important to update your information with the health insurance marketplace. This is because your subsidy is based on your expected income for the year. So if you make more income than you expected, you may have to pay back some of your subsidy through your income tax return. But if you make less income than you expected, you’ll get a bigger subsidy. You can update your information by logging into your account and selecting “Change in circumstances.”


Household size and income are two important factors that affect marketplace insurance. subsidies, and cost-sharing reductions. It’s important to estimate your household size and income for the year so that you can get the most accurate subsidy amount. And if your income changes during the year, be sure to update your information with the health insurance marketplace so that you can get the correct subsidy amount.

For other information direct from the federal government website managed by healthcare.gov

Answering Your Income Questions

How Does Household Size Effect the Children's Health Insurance Program (Chip)?

Household size is used to determine if a family can qualify for CHIP. To be eligible, a family must meet both an income test and a resources test. The income test looks at the amount of money a family earns each year. The resources test looks at the value of the things a family owns, such as savings accounts, real estate, and vehicles.

Is There Any Sensitive Information I Have to Provide?

No. The marketplace never asks for sensitive information like your Social Security number, credit card information, or bank account numbers.

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