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Factors that Could Affect Your Low Income Medical Insurance Subsidies in Wisconsin

These factors may change the type or number of subsidies you can receive.

Subsidies may help make medical insurance more affordable for low income families and individuals in Wisconsin. A number of factors may change the type or amount of subsidies you receive that help cover health insurance costs. These include:

Change in income

The major factor in determining subsidies, such as the Advance Premium Tax Credit (APTC), is your income. If you experience a change in income, that may result in a change to your subsidies. Subsidies are in place to help low income people in WI pay for medical insurance premiums and expenses.

These factors could affect your low-income medical insurance subsidies in Wisconsin.
  • Income increase – If you purchased your health insurance through the Health Insurance Marketplace the previous year and received APTC subsidies, you may be liable to pay back some or all of the premium tax credit you received when you file your taxes
  • Income decrease – If you file your taxes and your income is less than you estimated on your application through the Health Insurance Marketplace, you may be eligible for additional tax credits that help pay for your insurance costs from that tax year

Change in family size 

The following changes may affect your income and eligibility for APTC and must be reported to the Health Insurance Marketplace as soon as they occur:

  • Birth and adoption – may increase your subsidy level, depending on income
  • Marriage or divorce – may increase or decrease your subsidy level, depending on income

Moving out of Wisconsin 

This may change your subsidy level, because the cost of health insurance varies depending on where you live.

Having a dependent turn 26 years old 

Generally, at age 26, dependents can no longer get coverage through their parents’ policy. This results in a change in family size and may reduce the subsidy amount for the remaining family members. Fortunately, catastrophic coverage is available to provide people under 30 with a more affordable insurance option if they do not qualify for APTCs or other subsidies.

Gaining or losing health care coverage or eligibility 

If your family becomes eligible for other health coverage, this may affect subsidy eligibility.  For example, if a family member turns 65 and becomes eligible for Medicare, or a family member becomes disabled and is eligible for other programs, the subsidy for the rest of the family may change.

Any other changes affecting household size or coverage status may affect subsidies for low income medical insurance in Wisconsin.

Subsidies help provide affordable medical insurance options for low income residents in Wisconsin. If your subsidies have been reduced and your current plan is no longer affordable, get a quote for a new health plan, or call us at 608.644.3430.