Understanding the Federal Poverty Guidelines for Determining Cost Assistance on Plans Active in 2017

Below are the 2016 Federal Poverty Guidelines you’ll use for cost assistance on 2017 health plans, 2016 – 2017 Medicaid / CHIP, and taxes filed April 15, 2018.

You’ll the 2016 FPL guidelines for Medicaid until late January when the new poverty level guidelines are released. Then starting February you’ll use the 2017 FPL guidelines for Medicaid.

  • Premium Tax Credits are available to those making between 100% – 400% of the poverty level (FPL).
  • Out-of-pocket cost assistance is available to those making between 100%-250% FPL.
  • Medicaid/CHIP is available to everyone making less than 138% FPL, in states that expanded Medicaid. States that didn’t expand have different rules and CHIP eligibility is typically higher in all states.

Learn more about 2017 cost assistance.

TIP: New poverty guidelines are released each year, which table you use depends on which program we are discussing. Specifically, the table below is useful for determining healthcare cost assistance for the 2017 open enrollment season (Nov, 1 2016 – Jan, 31 3017) and all plans otherwise purchased in 2017.

TIP: To find any other poverty level amount, multiply the 100% poverty level dollar amount by the a percentage of the poverty level. If you want to see what 400% of the poverty level is, you can multiply the 100% Federal Poverty Level dollar amount by 4.00 (so for a 1 person household it is $11,880 x 4.00 = $47,520). For 300% FPL multiply by 3.00. For 250% FPL multiply by 2.50. For 138% FPL multiply by 1.38 etc.

TIP: Always round up to the nearest dollar for poverty levels and taxes. More information on the poverty level can be found on tax forms including the 8962 tax form.

Simplified 2016 FPL Guidelines for the 48 Contiguous States and DC (not Alaska and Hawaii). You’ll use these guidelines for 2017 cost assistance and for taxes filed April 15, 2018 

Persons in
Household
2016
100% Federal Poverty Level Minimum to Qualify for ACA Assistance
138% FPL Medicaid Cap (in States that Expanded) 250% FPL CSR Subsidies Cap 400% FPL Premium Tax Credit Cap
1 $11,880 $16,394 $29,700 $47,520
2 $16,020 $22,108 $40,050 $64,080
3 $20,160 $27,821 $50,400 $80,640
4 $24,300 $33,534 $60,750 $97,200
5 $28,440 $39,247 $71,100 $113,760
6 $32,580 $44,960 $81,450 $130,320
7 $36,730 $56,428 $91,825 $146,920
8 $40,890 $61,335 $102,225 $163,560
*Medicaid eligibility is different in states that did not expand Medicaid. Federal Poverty Guidelines are different in Hawaii and Alaska.

NOTE: If your family contained more than 8 people, add $4,160 for each additional person. Note that Hawaii and Alaska use different guidelines. This is unchanged from 2015.

2016 Federal Poverty Guidelines – For Alaska and Hawaii

2016 Poverty Guidelines for Alaska
Persons in
Household
100% Federal Poverty Level Alaska
For families/households with more than 8 persons, add $5,200 for each additional person.
1 $14,840
2 20,020
3 25,200
4 30,380
5 35,560
6 40,740
7 45,920
8 51,120
2016 Poverty Guidelines for Hawaii
Persons in
Household
100% Federal Poverty Level Hawaii
For families/households with more than 8 persons, add $4,780 for each additional person.
1 $13,670
2 18,430
3 23,190
4 27,950
5 32,710
6 37,470
7 42,230
8 47,010