Individual Health Insurance / Seguros de Salud

ObamaCare subsidies can save you money on your premium and out-of-pocket expenses. Cost assistance subsidies are only available through your state’s health insurance marketplace and are only available during open enrollment (unless you qualify for a special enrollment period) The exception is Medicaid and CHIP, which can be obtained at any time of year.

There are three types of cost assistance: Premium Tax Credits to lower your premiums, Cost Sharing Reduction subsidies for lower out-of-pocket costs, and Medicaid and CHIP.

ObamaCare’s Premium Tax Credits can be paid to your insurer in advance to lower your monthly premium on a Marketplace plan or adjusted on your tax returns. Tax Credits are based on income and available to folks making between 100% and 400% of the Federal Poverty Level FPL (between $11,670-$46,680 for an individual and between $23,850-$95,400 for a family of 4 in 2015).Type your paragraph here.

Tax credits are based on income and cap your monthly premium between 2% and 9.5% of your total house hold Modified Adjusted Gross Income (MAGI) per household member. Caps are based on the second lowest cost Silver plan. The less income you have the lower the percentage of your income you will pay. If your income changes slightly, then the exact amount of assistance you get will too. Each level of the Federal poverty line between 133%-300% equals a different Tax Credit amount, and it’s up to you to decide what percentage of that Tax Credit you want to be paid to your insurer in Advance.

A tax credit can be paid in advanced to your insurer through the Marketplace. This is called an Advanced Premium Tax Credit. The amount paid to the insurer is the difference between your premium cap and the cost of the plan. You’ll see that number reflected when you compare marketplace plans.

Be aware that you should report your income if it changes, or if you have another life change that could affect what premiums you get. If you report life changes the marketplace can adjust your tax credit for you, if not you may end up owing money or being owed money on your tax returns.

Tax credits can be paid in advance to lower your premium upfront or can be deducted from your Federal income taxes at the end of the year. If you didn’t take the full Tax Credit in advance, or you made less than you projected in 2014 and didn’t adjust your info in the marketplace, you can deduct the remaining amount on your Federal Income Taxes using Form 8962, Premium Tax Credit (PTC).

To learn if you qualify for lower costs on health insurance coverage, find your estimated 2015 household income and household size on the chart below. The column on the left tells you if you may qualify for premium tax credits, lower out-of-pocket costs, or low-cost health care through Medicaid.

You are eligible for a Tax Credit if:

• You shop through the Health insurance Marketplace
  
• Your income is between 100%-400% FPL
  
• You are not eligible for other coverage like employer based coverage (this is true even if you are a dependent and a family member offered coverage through another members plan)
  
• You are filing a joint return if married
  
• Cannot be claimed as a dependent by another person

ObamaCare’s Cost Sharing Reduction Subsidies (CSR) lower out-of-pocket costs, based on income, for Silver plans bought on the Health Insurance Marketplace. Along with Premium Tax Credits, ObamaCare’s Cost Sharing Reduction subsidies lower what you pay for health insurance costs.

CSR subsidies only apply to “covered costs” (in-network services covered on your plan). Covered costs usually include only items from ten categories of essential Health Benefits. When you compare plans you’ll see what services are covered in-network and will see the plans out-of-pocket costs reflecting your Cost Reduction Subsidies. Your insurer will only offer to cover part of your costs or count your costs toward your deductible if you use covered in-network services. If you shop out-of-network expect higher costs.

To qualify for Cost Sharing Reduction Subsidies you must:

Shop on the Health Insurance Marketplace (or your state’s Marketplace)
Make between 100% – 250% FPL
Obtain a Silver plan (CSR subsidies are only offered on Silver plans

The amount of out-of-pocket assistance you are eligible for is based on income and is offered to those making between 100% to 250% of the Federal Poverty Level (FPL). CSR subsidies do not lower your premium like Advanced Premium Tax Credits, as they apply only to cost sharing amounts. CSR subsidies reduce your out-of-pocket expenses by raising the actuarial value of your plan (the average out-of-pocket costs an insurer pays on a plan). Specifically, they raise coinsurance, and lower copays, deductibles, and maximum out-of-pocket costs you will pay in a policy period. This means that some folks will not only qualify for lower premiums on a Silver plan via tax credits, but may also get the out-of-pocket costs similar to a Gold or Platinum plan.

Income Level Actuarial Value (the amount of costs a Silver plan will cover due to cost sharing reduction subsidies for % of the Poverty Level).

100-150% FPL = 94% Actuarial Value (CSR 94)

150-200% FPL = 87% Actuarial Value (CSR 87)

200-250% FPL = 73% Actuarial Value (CSR 73)

More than 250% FPL = 70% Actuarial Value

Out-of-pocket maximum limits (equal to deductible limits):

100-200 percent of FPL,

your out-of-pocket limit won’t be more than $2,250 for an individual.
your out-of-pocket limit won’t be more than $4,500 for a family.

200-250 percent of FPL,

your out-of-pocket limit won’t be more than $5,200 for an individual.
your out-of-pocket limit won’t be more than $10,400 for a family.

More than 250% percent of FPL,

your out-of-pocket limit won’t be more than $6,600 for an individual.
your out-of-pocket limit won’t be more than $13,200 for a family.