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Affordable Care Act, Government Programs, Health Care Reform, Health Disparities, Health Insurance, Health Reform, Healthcare, Mental Health Care, Obama, Obamacare, Politics, Poverty, Public Health, Public Policy, Social Justice, Uncategorized

What You Need To Know About Health Insurance: Income Guidelines For Affordable Care Act Subsidies

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The Affordable Care Act’s marketplace divides plans into four categories based on how much health care each plan pays for. These categories are bronze, silver, gold, and platinum. Bronze plans pay for the least of your health care, so you have to pay more money during the year for services like doctor visits (but you pay the least in monthly fees, also called premiums). Silver plans pay a little more of your health care costs and have slightly higher premiums compared to bronze plans. Gold plans pay for even more of your health care costs, and platinum plans pay the most (but you pay the most in monthly premiums).

If you have a low income, you may be able to get extra financial assistance to help pay for health care services. To get this extra assistance, you must buy a special, low-cost plan in the silver category of your state’s marketplace. These special silver plans charge the same premiums as regular silver plans, but they pay for more of your health care than a regular silver plan would.

Everyone who can get this extra financial assistance can buy a special silver plan that lowers the maximum amount they pay for health care in a year (their “out-of-pocket limit”). People with low enough incomes can buy special silver plans that also have smaller copayments, co-insurance, and deductibles that are similar to what they would have in gold or platinum plans. (These costs are also called “out-of-pocket costs.”)

The table below shows how much extra financial assistance you could get if you buy a special, low-cost silver plan. The table shows how much lower your out-of-pocket limit would be. It also shows which category of plan your out-of-pocket costs (like copayments and co-insurance) would be similar to. (The table includes both individual and family coverage for families of two or more. This is because some family members might be able to get a different kind of health insurance, like a plan from their job or Medicaid. So, a man with a wife and one child might buy a family plan, but he might instead buy an individual plan just for himself if his wife and child can get other insurance.)

Examples

1. A single man with an income of $21,000 buys a special silver plan for himself. His out-of-pocket limit is $2,250. His plan also has lower out-of-pocket costs, so he gets the same value as he would have with a gold plan.

2. A single mom has two kids, makes $28,000, and lives in a state where her children can get Medicaid health coverage. She buys a special silver plan just for herself (an individual plan). Since she has three people in her family, she is able to get the most financial assistance. With her special silver plan, she has an out-of-pocket limit of $2,250, and she has smaller copayments and deductibles, so she gets the same value as she would have with a platinum plan.

3. A single mom has two kids, makes $28,000, and lives in a state where her children cannot get Medicaid coverage, so she buys a special silver plan for herself and her children. The out-of-pocket limit for her family is $4,500. As in example 2, she also has smaller copayments and deductibles, so she gets the same value as she would have with a platinum plan.

Table 1. Extra Financial Assistance Guidelines

Annual Household Income, 2014

Limits on Out-of-Pocket Costs for Individual/Family Plans*

You Will Get the Same Value as This Category of Plan**

Individual

Individual Plan

$11,490-$17,235

$2,250

Platinum

$17,236-$22,980

$2,250

Gold

$22,981-$28,725

$5,200

Silver (regular)

Family of 2

Individual Plan/Family Plan

$15,510-$23,265

$2,250/$4,500

Platinum

$23,266-$31,020

$2,250/$4,500

Gold

$31,021-$$38,775

$5,200/$10,400

Silver (regular)

Family of 3

Individual Plan/Family Plan

$19,530-$29,295

$2,250/$4,500

Platinum

$29,296-$39,060

$2,250/$4,500

Gold

$39,061-$48,825

$5,200/$10,400

Silver (regular)

Family of 4

Individual Plan/Family Plan

$23,550-$35,325

$2,250/$4,500

Platinum

$35,326-$47,100

$2,250/$4,500

Gold

$47,101-$58,875

$5,200/$10,400

Silver (regular)

*These out-of-pocket limits are lower than they would be for a regular silver plan ($6,350 for an individual or $12,700 for a family).

**Your lower out-of-pocket costs will be the same as they would be if you bought the type of plan listed.

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