More than 80% of Mainers with coverage through the Marketplace receive financial assistance to make their plan more affordable. When you fill out an application on CoverME.gov, you’ll find out if you qualify for Advance Premium Tax Credit (APTC) and/or Cost-Sharing Reductions (CSRs). Open Enrollment for 2022, the time of year where you can enroll in a plan through CoverME.gov, has ended. You may still be eligible to enroll in health insurance, or make changes to your plan, by qualifying for a Special Enrollment Period (SEP).
The financial assistance to help individuals and families lower their coverage costs was increased by Congress for 2021 and 2022, so more people than ever now qualify for financial help. If you haven’t been eligible for financial help in previous years, you should fill out an application to see what help may be available to you now. And if you already receive financial help with your marketplace plan, you may be eligible for additional premium reductions.
Advance Premium Tax Credits
Advance Premium Tax Credits (APTCs) are tax credits you can take in advance to lower your monthly health insurance payment, known as your premium. This type of financial assistance is based on your family size and income, and is only available to people who don’t get affordable health coverage offered through their employer.
If you are eligible for APTCs, the money will go directly to the insurance company, and you will pay less money each month for your health insurance.
The amount of APTC you receive is based on your estimated income for the year ahead. It’s important to make sure you make updates at CoverME.gov if your income changes, to avoid having to repay any overpayment of APTC when you file your taxes.
Cost Sharing Reductions
Cost-Sharing Reductions (CSRs) are discounts that lower the amount you have to pay for deductibles, copayments, and coinsurance. Cost-sharing reductions are often referred to as “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings. You can use a premium tax credit for a plan in any metal category, but if you qualify for a cost-sharing reduction too, you’ll get those savings only if you pick a Silver plan.
If you qualify for CSRs, you also have a lower out-of-pocket maximum — the total amount you’d have to pay for covered medical services per year. When you reach your out-of-pocket maximum, your insurance plan covers 100% of all covered services.
If you're a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, you may qualify for additional cost-sharing reductions. Visit our Information for Native Americans page to learn more.