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By Ryan Kennelly

August 16, 2016

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  • Individual & Family Health Insurance
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What are the 2021 Federal Poverty Levels?

August 16, 2016

  • Individual & Family Health Insurance

Every year, the perimeters of the Federal Poverty Level (FPL) increase based on the cost of living. Families need to understand where they fall on the FPL so they know whether they are eligible for Medicaid in their state or whether they are eligible for a federal Subsidy because they earn between 100 and 400 percent of the FPL, or whether they are eligible for a tax credit because they purchased a Silver plan and earn less than 250% of the FPL.

Household Size100%133%138%200%400%
1$12,880$17,130$17,774$25,760$51,520
2$17,420 $23,169$24,040$34,840$69,680
3$21,960$29,207$30,305 $43,920$87,840
4$26,500$35,245$36,570 $53,000$106,000
5$31,040$41,283$42,835$62,080$124,160
6$35,580$47,321$49,100$71,160 $142,320
7$40,120$53,360$55,366$80,240 $160,480
8$44,660$59,398$61,631$89,320 $178,640

For households with more than 8, add $4,540 for each additional person. Note: Eligibility for premium tax credits in coverage year 2021 is based on poverty guidelines for 2020.

FPL = federal poverty line.

Related: What Are Federal Poverty Levels Used For?

For purposes of the FPL affordability safe harbor, the FPL is determined by the state in which the employee is employed. The 2021 FPLs for the continental U.S. (48 contiguous states and the District of Columbia), Alaska and Hawaii are as follows:

  • Continental U.S.: $12,880 (up from $12,760 in 2020)
  • Alaska: $16,090 (up from $15,950 in 2020)
  • Hawaii: $14,820 (up from $14,680 in 2020)

For 2021, the FPL safe harbor is determined by multiplying 9.83% by the applicable FPL threshold and dividing that product by 12. The result is the monthly limit on the employee-only required contribution for the ALE’s lowest-cost health coverage option that meets minimum value.

To be eligible for a full (100%) premium subsidy, the individual must have countable income less than, or equal to 135% of the FPL for the applicable State and family size.

If the individual’s income is less than or equal to 135% of the FPL, he or she is eligible for a full premium subsidy, regardless of whether the individual’s countable resources are under the lower limit ($7,970 or less) or the higher limit ($13,290 or less). Although eligible for a full premium subsidy, the individual gets less help with deductibles and co-pays, if his or her countable resources are over the $7,970 limit but under the $13,290 limit.

Minimum Income

In addition to the maximum income to receive the premium subsidy, there’s also a minimum income to get accepted by the ACA marketplace. If your estimated income is too low, the ACA marketplace won’t accept you. They send you to Medicaid instead. In states that expanded Medicaid, the minimum income is 138% FPL. In states that didn’t expand Medicaid, the minimum income is 100% FPL. Here’s a map that shows which states expanded Medicaid and which states did not: Current Status of State Medicaid Expansion Decisions, Kaiser Family Foundation.

mceclip0.png

However, unlike the maximum income, the minimum income is only looked at the time of enrollment, not at the time when you file your tax return. If your estimated income at the time of enrollment is below the minimum, the ACA marketplace won’t accept you and they will refer you to Medicaid. If your estimated income at the time of enrollment is above the minimum and they accepted you, but due to unforeseen circumstances your income for the year ended up below the minimum, as long as you made the original estimate in good faith, you are not required to pay back the premium subsidy you already received.

If you qualify for savings on out-of-pocket costs and enroll in a Silver plan:

  • You’ll have a lower deductible. This means the insurance plan starts to pay its share of your medical costs sooner. For example, if a particular Silver plan has a $750 deductible, you have to pay the first $750 of medical care yourself before the insurance company pays anything (other than for free preventive services). But if you qualify for cost-sharing reductions, your deductible for a Silver plan could be $300 or $500, depending on your income.
  • You’ll have lower copayments or coinsurance. These are the payments you make each time you get care — like $30 for a doctor visit. If a Silver plan’s copayment is $30 for a doctor’s visit, if you enroll in the plan and qualify for extra savings, you may pay $20 or $15 instead.
  • You’ll have a lower “out-of-pocket maximum.” This means the total amount you’d have to pay in a year if you used a lot of care, like if you got seriously sick or had an accident, would be lower. Instead of $5,000, your out-of-pocket maximum for a particular Silver plan could be $3,000.

 

Medicaid Coverage by State

Overall RankStateTotal ScoreSpendingQualityEligibility & Enrollment
1Massachusetts76.441112
2Rhode Island69.32572
3Vermont68.994316
4Pennsylvania68.246621
5Connecticut68.098219
6Washington68.061147
7California68.0431114
8New York66.4310517
9Oregon64.68151011
10Louisiana64.4221171
11Alaska62.5512413
12New Jersey62.16133113
13Colorado61.787456
14Delaware59.94161625
15Virginia59.5422384
16New Hampshire58.8392340
17Ohio58.17182227
18Kentucky57.0632278
19Minnesota56.4922449
20Arizona55.9133329
21West Virginia55.67451310
22Hawaii55.59204022
23Michigan55.47351524
24Indiana55.39252526
25Maryland54.96142139
26Florida54.8628836
27New Mexico54.80273323
28Illinois54.67232829
29Wisconsin53.8631937
30Montana53.4724475
31Utah51.65411831
32Iowa51.59301247
33North Dakota50.98174432
34Texas50.74262645
35Nevada50.51364218
36Kansas50.27391442
37Arkansas50.02374320
38North Carolina49.02432035
39Maine48.95194830
40Missouri47.61293548
41Idaho46.57384915
42South Carolina46.37461938
43Nebraska44.70342950
44Alabama44.36503928
45Mississippi44.15493034
46South Dakota43.14423741
47Wyoming43.10443646
48Tennessee42.83404633
49Oklahoma42.44483444
50Georgia35.33475043

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