Sunday, July 28, 2013

Will You Receive an Obamacare Subsidy?

Maggie Mahar breaks down the details at her blog and

Find out the size of a Silver plan premium – and your subsidy.

Eleven states have announced the rates that insurers will be charging in their exchanges-marketplaces where individuals who don’t have employer-sponsored coverage can shop for their own insurance.

Middle-income as well as low-income people buying coverage in the exchanges will be eligible for government subsidies that will come in the form of tax credits. Anyone earning between 100 and 400 percent of the federal poverty level (FPL) (now $11,490 to $45,960 for a single person, and up to $126, 360 for a family of six) will qualify for a tax credit.

Knowing the price of a Silver plan in your region is key to calculating the size of your subsidy. Subsides will be tied to the cost of the second-least expensive Silver plan in your area. The architects of the Affordable Care Act (ACA) wanted to make sure that people who must buy their own insurance can afford that benchmark Silver plan, even in regions where health care is extremely expensive

In the exchanges, insurers will be selling Bronze, Silver, Gold and Platinum plans. All must cover the ten benefits that Congress decided are “essential” (outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, behavioral health treatment, prescription drugs, rehabilitative services, laboratory services, preventative care and pediatric services, including oral and vision care for children.)

All plans also must offer free preventive care, and they cannot refuse to cover you or charge you more because you suffer from a pre-existing condition.

The only major difference between the four tiers is that Bronze and Silver plans will boast lower premiums, with higher co-pays and deductibles-up to a maximum of $6,340. After that, the insurer pays for all essential benefits. Gold and Platinum plans’ premiums will be higher, but total out-of-pocket spending will be lower.

If your employer offers “affordable” comprehensive insurance, you will not be able to buy coverage in the exchange. You already are receiving a subsidy from your boss. The exchanges will be open only to the self-employed, the unemployed, and employees work for a company that does not offer affordable health benefits.

The size of your subsidy will be based on your income, the number of people in your household, and the price of the benchmark Silver plan in your region.

for tables and charts to get an estimate.

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