SILVER PLAN: Based on a 60 yr old, smoker, 1 person in family, adult, net income $19k
The information below is about subsidized exchange coverage. Note that subsidies are only available for people purchasing coverage on their own in the exchange (not through an employer). Depending on your state's eligibility criteria, you or some members of your family may qualify for Medicaid.
For example, you could enroll in a Bronze plan for about $0 per year (which is 0% of your household income). By enrolling in a Bronze plan, you would receive $4,691 in subsidies, which would cover the entire amount of your Bronze premium. For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
You are guaranteed access to a Silver plan with an actuarial value of 87%. This means that for all enrollees in a typical population, the plan will pay for 87% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.
Government official source: Kaiser Family Foundation:
- Household income in 2014:
- 165% of poverty level
- Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:
- 4.71%
(before accounting for a tobacco surcharge, if applicable) - Health Insurance premium in 2014 (for a silver plan, before tax credit):
- $6,730 per year
In most states, insurers can charge a tobacco surcharge of up to 50% of your total premium before the tax credit. The tax credit cannot be applied to the tobacco surcharge. - You could receive a government tax credit subsidy of up to:
- $5,836 per year
(which covers 87% of the overall premium) - Amount you pay for the premium:
- $894 per year
(which equals 4.71% of your household income and covers 13% of the overall premium)
Other Levels of Coverage
The premium and subsidy amounts above are based on a Silver plan. You have the option to apply the subsidy toward the purchase of other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).For example, you could enroll in a Bronze plan for about $0 per year (which is 0% of your household income). By enrolling in a Bronze plan, you would receive $4,691 in subsidies, which would cover the entire amount of your Bronze premium. For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
Out of Pocket Costs
Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $2,250. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.You are guaranteed access to a Silver plan with an actuarial value of 87%. This means that for all enrollees in a typical population, the plan will pay for 87% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.
Government official source: Kaiser Family Foundation:
