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Affordable Insurance Available at healthcare.gov

Posted on Thursday, February 6th, 2014


Are you an uninsured adult under age 65?
The deadline for you to buy a health insurance plan for 2014 is March 31.
For most Love County families, the best buy is through healthcare.gov.
This is the federal health insurance marketplace created by the Affordable Care Act, “Obamacare.”
The majority of Love County households will find that the full monthly premium of a plan purchased from the marketplace is subsidized.
A subsidy lowers your share of the cost in order to help you pay for the coverage you buy.
For lower income participants there is additional help paying your share of medical bills when you use your plan (more about this below).
The premium subsidies are available only when you enroll in one of the marketplace plans found at healthcare.gov.
People who qualify for a premium subsidy are those with 2014 incomes in the following ranges:
Individual:   $11,490-$45,960
Family of 2: $15,510-$62,040
Family of 3: $19,530-$78,120
Family of 4: $23,550-$94,200
Family of 5: $27,570-$110,280
Family of 6: $31,590-$126,360
Family of 7: $35,610-$142,440
Family of 8: $39,630-$158,520
For each additional person, add $4,020-$16,080
(Each line represents a percentage of the poverty line, ranging from 100% to 400%).
Individuals and families with earnings more or less than incomes within those ranges can still buy a plan at healthcare.gov, but they will pay the full monthly premium.
However, individuals earning less than $11,490 who qualify for Medicaid (Sooner Care) will be enrolled in Medicaid when they visit healthcare.gov.
To see estimates of your household’s plan premiums and subsidy in the marketplace, go to www.healthcare.gov. Click on “View Plans Before I Apply.”
After you respond to a few questions about age, household size, income, and other coverage, you will be able to compare plan prices and see how your subsidy lowers monthly premiums (See example below).
Or, request assistance. There are four ways to shop for, and enroll in, a marketplace plan:
In-person from those in Love County trained and certified to help. They include:
o       Big 5 Community Services in Marietta, at 276-3154
o       Melodie Schaffer, independent insurance agent at Pearman Insurance in
Thackerville, 276-3672.
Call for an appointment. Assistance is free.
Over the phone. Call the marketplace call center at 1-800-318-2596.
Online. Visit www.healthcare.gov.
Paper Application. Available at the website or from an in-person enroller.
Also, the Love County Library offers computers and help in logging into healthcare.gov.
There are 37 Oklahoma bronze, silver, gold, and platinum plans in the health insurance marketplace.
Generally, a bronze plan pays 60% of medical bills, a silver 70%, a gold 80%, and a platinum 90%, with the covered individual or family paying the rest of the medical bill (up to a maximum dollar amount per year -- the household’s “out of pocket limit”).
The plans are offered through three Oklahoma companies: Blue Cross/Blue Shield of Oklahoma, Global Health, and Coventry Health and Life.
In some cases, a plan’s full premium is equal to or less than the household’s expected “affordable” monthly payment. Therefore, no subsidy is required.
That is because the Oklahoma plans in the marketplace are fourth lowest cost in the nation.
Oklahomans with a private insurance plan may switch to a marketplace plan if their household income qualifies them for a subsidy and they find comparable or better insurance at healthcare.gov.
How Much Help Will Premium Subsidies Provide?
To calculate the premium subsidy (called “premium tax credit”), the marketplace starts by identifying the full premium of the second lowest cost silver plan that is available to the household. This is called “the benchmark plan.”
The amount of the premium tax credit is equal to the full premium of “the benchmark plan” that could cover the household, minus the household’s expected contribution for coverage.
The household is expected to pay a share of its income toward the premium. That share is based on a sliding scale designed, under the Affordable Care Act, to be a payment the household can “afford.”
Those who earn less have a smaller “affordable” payment, and those who make more have a larger “affordable” payment.
The range of “affordable” is a low of 2% of income at the lowest end of the income ranges shown for each household size in the above table, up to a high of 9.5% of income at the upper end of each income range.
For example:
John is 25 years old and has annual income of $22,980, which equals 200% of the poverty line. His expected “affordable” payment is 6.3% of his income or $1,448 a year. The benchmark ‘silver’ plan available to John has a full premium of $2,088 a year or $174 a month. John would be eligible for a premium subsidy of $640 ($2,088 minus $1,448) a year, or $53.33 a month.
John could apply his premium subsidy amount of $640 a year ($53.33 a month) toward any bronze, silver, gold or platinum plan he buys in the marketplace.
In John’s example, the lowest premium plans in the marketplace, after applying his premium tax credit, are as follows:
Bronze –   $744 a year ($62 a month)
Silver –      $1,392 a year ($116 a month)
Gold –       $1,896 a year ($158 a month)
Platinum - $2,508 a year ($209 a month)
Because John’s income is less than 250% of the poverty line, he will receive savings on out-of-pocket medical costs. To qualify for the savings, he must select a silver level plan. The savings raise the plan’s share of payments to more than 70%.
The above examples are estimates. Actual subsidies and plan premiums are computed at the time of enrollment.
(This is the second in a series of articles through March 31 about the Affordable Care Act. The articles are saved on the hospital website, www.mercyhealthlovecounty.com.)