Learn the size of your subsidy without going through HealthCare.gov

Consumer Reports

There's a good chance you are eligible for a subsidy to lower the cost of your health insurance premium. To know for certain, use our free online too, HealthLawHelper.org. Our tool, however, can't tell you how big that subsidy will be. And if you live in one of the 36 states whose Marketplace goes through HealthCare.gov, you can’t get that information without going through the laborious process of filling out a full application. To help you out, we've now tried several alternative subsidy calculators and found pros and cons with each.

We gave them a test designed to trip them up, based on a real query sent by a reader. It involves a household with an older husband on Medicare, and a wife, age 58, who needs insurance. The couple’s only income is $19,000 from the husband’s Social Security check.

This is a tough question, because it has a different answer depending on the state the couple lives in. In states that are expanding Medicaid to cover all low-income households, the wife would automatically be put into that program. In states that aren’t expanding, she’s eligible for substantial premium subsidies as well as help with out-of-pocket costs. We checked using zip codes in Illinois, which is expanding Medicaid, and Florida, which is not, to see whether the calculators could pick up the difference.

The good news is that in Florida, every one of the five calculators we tested came up with the same premium subsidy, a whopping $453 a month. Other results varied. Here’s our field report:

Calculator

Illinois Medicaid eligibility identified?

Florida premium subsidy

Florida cost-sharing reduction mentioned?

GetInsured.com - web insurance broker

Yes.

$453

Yes. But no information on size of reduction.

Kaiser Family Foundation - nonprofit health policy organization

Yes.

$453

Yes. Stated that maximum annual out-of-pocket limit would be $2,250.

Ehealthinsurance.com - web insurance broker

Yes.

$453

No.

HealthSherpa - pop-up site built by three West Coast tech whiz kids

No. Gave premium subsidy information instead.

$453

No.

Get Covered America - nonprofit group promoting enrollment in Health Insurance Marketplaces

Yes.

$453

No.

Got a question for our health insurance expert? Ask it here; be sure to include the state you live in. And if you can't get enough health insurance news here, follow me on Twitter @NancyMetcalf.

—Nancy Metcalf

Health reform countdown: We are doing an article a day on the new health care law until Jan. 1, 2014, when it takes full effect. (Read the previous posts in the series.) To get health insurance advice tailored to your situation, use our Health Law Helper, below.



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