Question: If you look at the income chart on CoveredCA, it looks like a household of 3 will qualify for a subsidy as long as their household income is under $78,120. But only one family member of the household needs coverage. According to the shop and compare tool, this family member does NOT qualify for a premium subsidy. If I recalculate and say that all three members of the family need coverage, then they do qualify for a subsidy. What gives?
Answer**: “Your fair share” of the premium is established as a percentage of your income. For a 3-person household with an income of $78,000, your fair share is 9.5% of income. That equates to about $620 per month. This number is a constant regardless of who is to be covered. If all three members of the household need coverage and the premium is $1120 per month, you’ll get a subsidy of $500 per month to cover the difference. If only 2 people need coverage, your fair share is still $620, and if the premium for 2 people is $720, you’ll get a subsidy of $100 to cover the difference. But if only one person needs coverage, your fair share is still $620, but the premium is only $300. So you pay the $300 without a subsidy.