Healthcare Reform: Affordable Care Act (ACA)

The Affordable Care Act (ACA) brings a whole new approach when shopping for medical benefits. You have the option to purchase plans direct from the insurance carrier or purchase plans through the new marketplace called the WA Healthplanfinder (i.e. exchange). The benefit of purchasing plans within the exchange would be the potential financial assistance you may be eligible to receive via the Premium Tax Credit. This tax credit amount can be used to help lower your monthly premium payment, or lower the amount you pay at tax time.
Generally, you will qualify for the Premium Tax Credit if:

  • Your employer and/or your spouse‚Äôs employer DOES NOT offer a group medical plan.
  • You DO NOT receive Medicare.
  • Your family income (total household gross income) is less than 4x the federal poverty level (example below).


Number of People in Family/Household 2022 Coverage (based on 2021 poverty level) 2023 Coverage (based on 2022 poverty level)
1 $12,880 $13,590
2 $17,420 $18,310
3 $21,960 $23,030
4 $26,500 $27,750
5 $31,040 $32,470
6 $35,580 $37,190
7 $40,120 $41,910
8 $44,660 $46,630
NOTE: For families/households with 8 or more persons, add the following amount per each person, $4,540 for 2022 coverage and $4,720 for 2023 coverage.

Once you have determined if you qualify for assistance, you may also be eligible for additional help. The chart below illustrates the types of assistance available:

Example of Assistance Types
Cost Assistance Type for 2023 Individual Annual Income Family of 4 Annual Income
Medicaid/Apple Health Up to $18,754 Up to $38,295
Premium Tax Credit (only available when purchasing a marketplace/exchange plan $13,590-$54,360 $27,750- $111,000
Cost Share Reductions (only available when purchasing a SILVER plan through the marketplace/exchange) $13,590- $33,975 $27,750- $69,375

The IRS has provided a tool to help you determine a potential Premium Tax Credit. To see if you may qualify, just enter in your information in the Tax Credit Estimator.

If you do meet these parameters and would like to enroll in a plan through the WA Healthplanfiner, CGA Benefits can still assist you with that process. Likewise, if you wish to enroll Outside the exchange, we remain your resource to do so.

Employers are bound to a new set of rules. If you are an employer and want more information on these rules, you can find more information here:

Small Group Employers (50 or less)

Large Group Employers (51+)