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Income determines eligibility for health insurance subsidy

Your income determines your eligibility for government-subsidized health

Your income determines your eligibility for government-subsidized health insurance. Credit: iStock

This is the second of two columns about assistance for health insurance.

How much can my 26-year-old daughter earn and still qualify for a subsidized health insurance policy in the new insurance exchange?

The federal government now subsidizes premiums for single people with up to $45,960 in annual income, and for families of four with an annual income of up to $94,200. If you meet eligibility requirements, you also may qualify for lower annual out-of-pocket costs.

The subsidy is in the form of a tax credit based on income. Your daughter can have her credit sent directly to the insurer as part of her monthly premium payment. If her income fluctuates, she can adjust the size of her credit during the year. It's particularly important to reduce the credit if her income rises, because at year-end, if it turns out that she received a bigger subsidy than her income entitled her to, she must repay the excess.

The total cost of a policy purchased in the exchange (called New York State of Health) depends partly on the category of coverage she chooses. There are four policy categories -- Bronze, Silver, Gold and Platinum. Bronze plans carry the lowest premiums and highest out-of-pocket costs; Platinum plans have the highest premiums, but lower out-of-pocket expenses. But they all provide the same package of benefits, which includes hospitalization and prescription drug coverage. Their doctor and hospital networks vary.

The next open enrollment period in New York State of Health begins Nov. 15. But enrollment is open year-round for anyone who has experienced a "qualifying event," such as divorce, loss of a job or becoming too old for coverage as a dependent child.

The bottom line Your income determines your eligibility for government-subsidized health insurance.

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TO ASK THE EXPERT Send questions to Ask the Expert / Act 2, Newsday, 235 Pinelawn Rd., Melville, NY 11747, or email Include your name, address and phone number. Questions can be answered only in this column. Advice is offered as general guidance. Check with your own advisers for your specific needs.