Unlucky in Coverage writes from the Southwest:
I am self-insured. I was quite pleased last year when I had a chance to purchase health insurance through the Federal Marketplace because my new plan was significantly less expensive and more comprehensive than the coverage I had previously. However, I just learned that my (Gold Plan) insurance is jumping from $399 to $508 a month – that’s 29%! I’ve been reading reports that the average rate increases are only a few percentage points but all of those studies are based on the lowest-priced Silver Plans.
Quick: If you had to chose a limited number of measures to gauge success of the Affordable Care Act, what would you choose? Would it be the number of persons who have enrolled in healthcare.gov?
The number of persons who have paid for their insurance and have coverage? The number of young people with coverage? The degree of spin used by the White House?
The U.S. House of Representatives thinks it’s an important topic. They just passed legislation requiring weekly updates on the operation of healthcare.gov.
But here is one proposed measure that can help cut through the maze of competing claims and partisan spin:
The percent of persons with either 1) “silver” or 2) “bronze” plans who have gone two or more months without paying their insurance premium.
Why, you ask? The silver and bronze plans, because their monthly premium is lower, will attract a disproportionate number of persons who were previously unable to afford health insurance and are now newly insured.
According to this just published JAMA article, even if their monthly premiums are fully or partially subsidized, these lower-cost insurance plans cover only up to 60% to 70% of medical expenses.That means cost sharing that can be excess of $6000 and $12,000 for individuals and families, respectively.
Beginning in 2014, millions of Americans will discover that they qualify for subsidies designed to help them purchase their own health insurance. The aid will come in the form of tax credits, and many will be surprised by how generous they are.
Not only low-income, but moderate-income families earning up to 400 percent of the federal poverty level (FPL) – currently $44,680 for a single person and $92,200 for a family of four – will make the cut. Within that group, households bringing in less than 250 percent of the FPL ($27,925 for a single person, $57,625 for a family of four) also will be eligible for help with out-of-pocket costs.
If your boss offers benefits, you won’t qualify, unless …
If your employer offers health insurance you won’t be eligible for a tax credit – though there are two exceptions to this rule:
- If your share of the premium for your employer’s coverage would exceed 9.5 percent of your income, or
- If your boss offers a skimpy policy that pays for less than 60 percent of an average worker’s covered benefits, you will qualify for help.
If I qualify, how much will I receive?
The size of the tax credit depends on your income, your age, how many people are in your family, and where you live.