There are a lot of big subsidies out there. A married couple, each one age 64, who make exactly 400% of the Federal Poverty Level-- so their income is $64,960 a year-- has to pay $517 a year if they buy the reference Silver plan.
The smallest subsidy they will get in any state on the federal exchange, in any area of that state, is $738 a month. The maximum they’ll get is $4190, if they live in Monroe County in Florida.
My state has its own exchange - it’s not on healthcare.gov
@Barbalot – off-exchange plans are currently subject to the same requirements as to ACA, but simply are not eligible for either a subsidy or a premium tax credit at tax time. That could change in the future but right now, the plans all have to meet the same requirements for preventive care and overall coverage (no lifetime limit, caps on annual out-of-pocket max, etc.).
If you are certain that you are not eligible for the tax credit, then there is no particular need to buy on-exchange. But if income fluctuates or is on the cusp for eligibility, then an off-exchange plan means foregoing a potential tax benefit potentiall worth thousands of dollars.
But depending on state there might also be significant differences in the way some off-exchange plans are structured, because while the actuarial math has to agree for each metal tier, insurance companies can fiddle around with copayment/deductible structure and networks. So they might offer an equivalent plan with higher deductible but lower copays… or lower deductible but higher copays – or a restricted network HMO vs. PPO. So if you are not subsidy-eligible then you might find plans with lower premiums off-exchange just because of minor differences like that.
“There’s no penalty for falling short, and whose to day that she can’t make another $200 in 2018 above and beyond what she made in 2017.” Can someone really overestimate their income, get the subsidy and not have any consequence next year?
Recall that the ACA was written expecting that all states would expand Medicaid. So it’s not clear why the ACA writers would contemplate clawing back subsidies from people whose incomes turned out to be too low for subsidies-- they could have had Medicaid for free, so there wouldn’t be suspicion of cheating.
People on this site often denigrate Medicaid, but in states that did expand, people on the lower end of subsidized insurance tend to envy people on Medicaid for getting free health care.
The clawback is intended to recover funds from people with higher earnings in any case. If somoene says they are making $15,000 to qualify for subsidies, and that person really earns $100,000 – then the government really is going to want to recover the money. But there is no point in going after someone who is too poor because they fall short of a minimum - as CF points out, the legislatie intent was that those 99% earners were going to be covered by Medicaid. If some states want to deny them access to care that’s not really a concern for the federal government – yes tax dollars are going to their subsidies, but tax dollars go to expanded Medicaid in all the expansion states.
The person might have problems getting initially qualified for the exchange policy if their previous tax returns aren’t ballpark for the amount they claim they will earn. If I were to claim that my income would only be $20K for next year, I’d get a request for income verifcation because that number is so far off from previous years. (Obviously in some cases that would happen, such as where someone has lost their job or retired or moved from full time employment to part time – but the point is, I’d be asked for evidence). But if I estimate next year’s income to be $2000 over the previous year it is going to be automatically approved, because it’s ballpark – people get raises, they choose to work extra hours, etc. So it’s very normal for someone’s income to slightly up – I mean, even when my kids worked part time, minimum wage jobs they would get raises after working at the same place for awhile.
At minimum wage ($7.25) it takes 1,587 hours to earn $11,500 (or roughly a 30-hour work week). Give that person a 65-cent hourly raise, and their earnings will go up to $12,537. Or they could keep working at the same minimum wage job but increase work hours by 3 hours every week, and see the same increase.
Was Medicaid user. Around here, it’s fantastic.
For two of the years I was on the exchange, I overestimated my income. One year, I ended up having medicaid-level income when I budgeted for the exchange. I ended up being literally about a hundred dollars under the medicaid limit. No issues. My premium was completely covered so no adjustments were needed at the end of the year.
The other time I overestimated but was still over medicaid level. I think I got a credit that year but I can’t remember 100%.
Earlier their was discussion of the FPL and the 100% amount, but isn’t it the 138% amount one must earn to qualify for subsidies instead of Medicaid?
Household Size 100% 138% 150% 200% 250% 300% 400%
1 $12,060 $16,643 $18,090 $24,120 $30,150 $36,180 $48,240
@somemom, In expansion states, it’s 138%, but in non-expansion states it’s 100%.
That’s only in Medicaid expansion states - see https://www.kff.org/health-reform/fact-sheet/aca-open-enrollment-if-you-are-low-income/
That’s because the medication expansion actually covers people up to 138% of FPL.
I’ve been playing around with the 2018 premiums on the Federal Exchange. The variations in costs are extreme.
There are some cases where subsidized 64-year-olds can get free Gold insurance, and a lot of cases where even subsidized 21-year-olds can get free Bronze.
A tale of two countries. So sad this is what it is coming down to.
http://enews.earthlink.net/article/us?guid=20171029/848ec6ef-8f21-4711-91d7-67f4a5b3b01c
Open enrollment starts Wednesday (Nov. 1) in all 50 states and DC.
I’m ready to help anyone who has questions about enrollment, on exchange or off exchange.
DD spoke to a broker today. The GA Kaiser rates are not yet up… yet the broker said…Kaiser will be doing all their applications on PAPER. Say what??
Ambetter won’t work with the brokers…but the broker will compare the plans with our DD.
Broker suggested a HSA, maybe…but DD has no income…so we would be funding that. Not sure Ambetter had that choice…and DD is not leaning towards Kaiser.
You don’t have to fund an HSA at all. You can buy the HSA policy and not put any money in the HSA, if you want.
Well…it’s an option my kid will look at.
But right now the Ambetter policy is looking fine. One of the Silver plans. Same price as her old Anthem POS… it not as good a policy…but it will work for her.
She will look at their bronze plan too.
I thought I’d pass this on from the LA Times. I hadn’t realized that the rules changed this year allowing children 15 and up to be charged more for health insurance.
http://beta.latimes.com/business/la-fi-obamacare-health-insurance-premiums-20171102-story.html
@AlbionGirl – interesting, and I had not known that either. Meanwhile, my children’s medical costs were higher through age five than the next dozen years, until acne treatment started.
Off to a bad start. I entered all my info on Healthcare.gov and got a message that my identity could not be verified. I see this message: “To verify your identity, call the Experian help desk at (866) 578-5409 and give them your code below.” First of all, there is no code. But, let me guess: I bet they can’t verify my identity if I have a credit freeze on.
I was wrong - credit freeze not an issue. I have no idea why they couldnt verify my identity. I called Experian, went through a painful process of answering a bunch of questions, and finally, they verifed me - so back to Healthcare.gov