Every person below 400% of the federal poverty level (FPL) will be eligible to receive some form of assistance or subsidization in paying for their health insurance and healthcare costs under Obamacare. These subsidy and assistance programs will not be the same for everybody, and they can be confusing for those unfamiliar with the affordable care act. 

Every person with-or-without health insurance will fit into the following four categories under Obamacare : 

 

Full Assistance & Medicaid (anyone at or below 138% FPL)

Subsidized With Cost-Sharing (Up to 250% FPL)

Subsidized Insurance Only  (250%- 400% FPL)

Everybody else (above 400% FPL) 


 

Before you start thinking about assistance, it's important to know that some people will not be affected by insurance changes brought about by the Affordable Care Act at all. If you are: 

Insured through work or  

currently enrolled in Medicaid or Medicare 

You are done, and don't need to do anything to comply with the law. But if neither of the phrases above describes you, you must enroll in an ACA compliant health insurance policy before December 15th to get coverage that becomes active on January 1, 2014.

No Assistance 

(Above 400% FPL)

>$46k 

 

These people earn more than $45,000 as individuals or more than $94,000 as a family of four. These people are ineligible for premium assistance as well as cost-sharing, but everyone becomes eligible for Medicare 2 months before their 65th birthday. 

These people traditionally do not have as many financial obstacles to their health care and health insurance access as those in the other categories. Odds are that if you are in this category, you can afford your insurance premiums.

Some of these folks will see their premiums go up under the ACA, especially if they were formerly enrolled in a 'cadillac plan' also known as a low deductible plan with a high actuarial rate. The ACA includes provisions to discourage these cadillac plans because they encourage wasteful spending by empowering enrollees to request unnecessary medical services due to their extremely low consumer share-of-cost.

The good news for folks in this group who are already up in arms about rate-hikes is that the ACA also caps the maximum percentage of consumers' annual income which can be obligated to spend on their health insurance costs. If you are in this category, and the cheapest insurance plan on the exchange still would cost you more than 8% of your annual income  please call us today so that we can figure out what the problem is.

Premium Assistance Only

(Anyone with annual income at 250%-399% FPL) 

$28k - $45k 

 

A visit to a primary care physician on a basic silver-plan for someone in this category will likely cost about $45. And a specialist visit on the same plan would cost $65. We can be a great help to you* call now. 1-800-771-7758

These folks make enough money to disqualify them from cost-sharing programs (CSP), but sometimes not enough to pay their premiums without help. 

For these people, premium assistance will keep their monthly costs low, but they will be required to pay all of their out-of-pocket costs themselves. Alternatively, they could buy a supplemental insurance plan to help cut those out of pocket costs, but that may not be effective if they don't use their covered services often.

The best strategy for this group is to shop around aggressively for coverage. The ACA law was not designed to help this group specifically, but that doesn't mean that they cannot benefit from it. That's where we come in. 

 

Middle Class Families

Essentially if you're caught in the no-man's land of the American middle-class during health care reform, you are likely to see a jump in your premiums, and you therefore have the highest interest in finding the most affordable insurance options for your family.

The free insurance quote services we offer our clients can make a huge difference to this group because they have so many options to choose from and distract them from which is their best insurance choice. 

An illustration of this point would be: 

If you are living below 138% FPL, you are most likely going to end up on Medicaid or another free or cheap insurance alternative. These folks don't have too much to lose since all of those plans meet certain minimum requirements by complying with the ACA and their income is so low they won't have to pay much one way or the other. 

This observation is almost as true for the group to the right of you as well. If your income is more than four times the FPL, you're basically choosing how much you want to spend, not what you can afford.

But for the truly middle-class who get subsidies but no cost sharing, are too old to stay on their parents plan but not old enough for Medicare, and who are self-employed or ineligible to receive insurance through their workplace; Our thorough and free quotes service can mean the difference between loving and hating the Affordable Care Act.

The health exchange markets and the new and innovative insurance products being sold there are shifting the focus of American healthcare from one of diagnosis, treatment and healing, to one of preventive services and early detection so that you can avoid going to the doctor in the first place. 

Before you decide to take the tax penalty, call us and we'll make sure your family doesn't have to miss out on the new age of health and wellness because you make both too much and not enough money.

Full Assistance

(Anyone with annual household income at or below 138% of the FPL)

<$14k 

 

A primary care visit is free on Medicaid and only three dollars on a silver plan with the 94% cost-sharing option available to those with an income at or below 150% FPL.

These are the folks the law was created for. Some 16 million Americans will finally have access to health insurance for little or no-cost under the ACA. 

Your coverage options at this price level include free coverage through Medicaid, and low-cost options in both the bronze and silver tiers of private insurance plans sold at Health Exchanges.

*In order to be eligible for cost-sharing programs to help with out-of-pocket costs you must enroll in a silver plan or better.

 

Partially Subsidized Plus Cost-Sharing Reductions

(Anyone below 250% FPL can be part of this category, but it is primarily for those between 139%-250% FPL.)

<$28k

There are so many enrollment options for this group that a primary care visit might be free or cost upwards of $45. Seriously, this is what we specialize in so if this is your category, call us now to learn more about your options.

Everyone in this group gets subsidized health insurance, but the subsidies increase as you get closer to the bottom end of the income scale.

In order to also get help with your out-of-pocket costs, you must sign up for a silver plan or better.

Cost Sharing Reductions

Within the silver plan category there are three tiers of cost-sharing. the higher the actuarial value of the plan, the lower your share of cost will be. the actuarial value determines how much of your healthcare costs your policy will actually be responsible for.

Cost sharing programs are off the menu if you make more than about $29k annually, but for everyone else, they can make an 'O.K.' insurance plan into an excellent one. 

For example: A primary care visit on a silver plan without CSR can cost you $45, but if you are on an 87% actuarial CSR silver plan, that same visit would only be $15 out-of-pocket.