Annual Premium Amount and Tax Credits for a Family of Four Under the Affordable Care Act, 2014, by Percent of Federal Poverty Line (FPL)

	Premium tax credit	Required premium payment by policy holder
138% FPL ($32,326)	$11,065	$1,065
150% FPL ($35,137)	$10,725	$1,405
200% FPL ($46,850)	$9,179	$2,952
250% FPL ($58,562)	$7,416	$4,714
300% FPL (70,275)	$5,454	$6,676
500% FPL ($117,125)	$0	$12,130
Full Premium		$12,130

Source: Commonwealth Fund Biennial Health Insurance Survey, 2012