Issue link: http://accesshealth.uberflip.com/i/155517
5/ accessHealthnews.net Summer 2013 ACA and Your Money Expected marketplace out-of-pocket costs accessHealth Staff (Information provided by U.S. Department of Health and Human Services, Region 7) Expected premiums for health insurance marketplace For Individuals Approximate % of FPL Approximate Contribution $13,788 120* 2% of income $23 2/3 6% $16,200 141 3.5% $47 2/3 6% $20,107 175 5.15% $86 2/3 13% $25,852 225 7.18% $155 1/2 27% $31,597 275 8.78% $231 0 30% $40,215 350 9.5% $318 0 30% Annual Income Ø Ø Ø Ø Ø Ø Out-of-Pocket Monthly Premium Portion of Maximum Total costs Incomes below 250% of the poverty level qualify for lower co-pays and deductibles. * This level of income would be eligible for Medicaid in states that expand their programs in accordance with the Affordable Care Act. Expected premiums for health insurance marketplace For a family of 4: Approximate % of FPL Approximate Contribution $28,260 120* 2% of income $47 2/3 6% $33,205 141 3.5% $97 2/3 6% $41,212 175 5.15% $177 2/3 13% $52,987 225 7.18% $317 1/2 27% $64,762 275 8.78% $474 0 30% $82,425 350 9.5% $653 0 30% Annual Income Ø Ø Ø Ø Ø Ø Out-of-Pocket Monthly Premium Portion of Maximum Total costs Incomes below 250% of the poverty level qualify for lower co-pays and deductibles. * This level of income would be eligible for Medicaid in states that expand their programs in accordance with the Affordable Care Act. Marketplace health plans: The projected prices above are estimated on the price of a silver plan which covers about 70% of costs. Incomes that reach 350% of the poverty level, hit a maximum contribution of 9.5% of income, or $318 per month. At the lowest levels, individual policies could cost about $23 per month. ● Gold plan - covers about 80% of costs; enrollee pays about 20% ● Platinum plan - covers about 90% of costs; enrollee pays about 10% The enrollees' contributions are based on aggregate costs under the plan when benefits are provided to a standard population. This may not be the Medal plan coverage levels same of every (or any specific) These estimates are based on a enrolled person. plan's level of coverage–plus the monthly premium: Tax credits ● Bronze plan - covers about Beginning in 2014, tax credits 60% of health care costs; will be offered to help purchase enrollee pays about 40% of insurance through the costs marketplace. Credits will be ● Silver plan - covers about available for incomes up to 70% of health care costs; 400% of the poverty level. This enrollee pays about 30% means that an individual can make up to $45,960 to qualify for the credit. A family of four can make up to $94,200 to qualify. ACA offers what is called an Advanced Premium Tax Credit or (APTC), designed to lower the cost of insurance purchased on the marketplace. Eligibility is based on household income and family size at the end of the tax year. amount) to apply immediately toward their premium each month. If the amount of the advanced payments for the year is less than what is due, a refund of the difference will be calculated on the individual or family tax return. If the advanced payments for the year are more than the credit the individual or family qualifies for, a repayment of the difference is required with the tax return. Important note: Advanced Premium Tax Credits are based on projected household income. This is why these payments are reconciled at tax time against the actual premium tax credit, as Individuals and families who income may change. Advanced qualify may choose how much of payments are paid directly to the APTC (up to the maximum the insurer. Incomes between 100% and 400% of the poverty level or $23,550 for an individual and $94,200 for a family of four in 2013 will qualify.