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Calculate your Premium Subsidy

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# in Household *
1
2
3
4
Your cost is
If your total monthly/yearly household income is:

$1,812/
$21,744

$2,439/
$29,268

$3,065/
$36,780

$3,692/
$44,304

$60/mo
If your total monthly/yearly household income is:

$2,039/
$24,462

$2,744/
$32,928

$3,449/
$41,391

$4,154/
$49,842

$122/mo
If your total monthly/yearly household income is:

$2,265/
$27,180

$3,048/
$36,576

$3,832/
$45,984

$4,615/
$55,380

$149/mo
If your total monthly/yearly household income is:

$2,492/
$29,898

$3,353/
$40,236

$4,215/
$50,580

$5,077/
$60,918

$177/mo
If your total monthly/yearly household income is:

$2,718/
$32,616

$3,658/
$43,896

$4,598/
$55,176

$5,538/
$66,456

$205/mo
If your total monthly/yearly household income is:
Over
$2,718/
$32,616
Over
$3,658/
$43,896
Over
$4,598/
$55,176
Over
$5,538/
$66,456
$435/mo

* A household is defined as the number of related people living in the same house. Some exceptions apply. Please call 1 800 250 8427 for details. Rates effective January 1, 2010.

July 2009 Calculation tool: http://www.policyintegrity.com/Eligibility.html

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