Individual & Family
Reliable insurance products and support to cover individuals and families throughout life’s stages. The experts at Graber & Associates are here to make the details easier.
Coverage Considerations
Depending on your household income, you may qualify for a “Premium Tax Credit” and possibly “Cost Share Reductions” through the Health Insurance Marketplace. Below are factors to consider when evaluating individual and family coverage options:
- Household size
- Anticipated modified adjusted gross income (MAGI)
- Healthcare providers
- Other coverage availability, such as employer sponsored coverage
- On-Marketplace vs. Off-Marketplace options
On-Marketplace: Income Count and Household Size
What to Include as Income
When you fill out a Marketplace application, you’ll need to estimate what your household income for the year.
- Marketplace savings are based on your expected household income for the year you want coverage, not last year’s income.
- You’ll be asked about your current monthly income and then about your yearly income.
Whose Income to Include in Your Estimate
For most people, a household consists of:
- The tax filer
- Their spouse if they have one
- Their tax dependents, including those who don’t need coverage
The Marketplace counts estimated income of all household members.
What income types to count:
- Alimony from divorces and separations finalized before January 1, 2019
- Capital gains
- Excluded (untaxed) foreign income
- Federal taxable wages (from your job)
- Investment income
- Rental and royalty income
- Retirement or pension income
- Self-employment income
- Social Security
- Social Security Disability Income (SSDI)
- Tips
- Unemployment compensation
Don't count these income types:
- Alimony for divorces and separations finalized on or after January 1, 2019
- Child support
- Child Tax Credit checks or deposits (from the IRS)
- Gifts
- Proceeds from loans (like student loans, home equity loans, or bank loans)
- Supplemental Security Income (SSI)
- Veterans’ disability payments
- Worker’s compensation
Report Income Changes to the Marketplace
Once you have Marketplace health insurance, it’s important to report any income changes as soon as possible and annually during the Open Enrollment Period. Failing to do so could mean missing out on savings or owing money back when you file your federal tax return.
On-Marketplace: Federal Poverty Level
The Marketplace uses a number called “modified adjusted gross income” to determine if you qualify for savings. This can determine whether an individual and/or family will qualify for a Premium Tax Credit and possibly Cost Share Reductions (CSR).
- Income below 138% Federal Poverty Level (FPL): If your income is below 138% FPL, and your state has expanded Medicaid coverage, you may qualify for Medicaid based only on your income.
- Income between 138% and 400% FPL: If your income is in this range, in all states you qualify for a premium tax credit that lowers your monthly premium for a Marketplace health plan.
- Income below 250% FPL: If your income is below 250% FPL, you qualify for savings on out-of-pocket costs when enrolled in a Silver plan.
- Income above 400% FPL: If your income is above 400% FPL, you may qualify for a premium tax credit that lowers your monthly premium for a Marketplace health plan.
Federal Poverty Levels for 2025
| Household Size | 100% | 138% | 150% | 200% | 250% | 300% | 400% |
|---|---|---|---|---|---|---|---|
| 1 | $15,650 | $21,597 | $23,475 | $31,300 | $39,125 | $46,950 | $62,600 |
| 2 | $21,150 | $29,187 | $31,725 | $42,300 | $52,875 | $63,450 | $84,600 |
| 3 | $26,650 | $36,777 | $39,975 | $53,300 | $66,625 | $79,950 | $106,600 |
| 4 | $32,150 | $44,367 | $48,225 | $64,300 | $80,375 | $96,450 | $128,600 |
| 5 | $37,650 | $51,957 | $56,475 | $75,300 | $94,125 | $112,950 | $150,600 |
| 6 | $43,150 | $59,547 | $64,725 | $86,300 | $107,875 | $129,450 | $172,600 |
| 7 | $48,650 | $67,137 | $72,975 | $97,300 | $121,625 | $145,950 | $194,600 |
| 8 | $54,150 | $74,727 | $81,225 | $108,300 | $135,375 | $162,450 | $216,600 |