How it will work for those that qualify for premium assistance

Do you currently have your own health insurance (non employer) or are curious to know what your premiums may turn out to be in 2014?

In 2014 your premiums will be based on family size and income (Modified Adjusted Gross Income (MAGI)).

If your income is at 400% of the federal Poverty Level (FPL) or lower then you and your family may be eligible for premium subsidy when purchasing coverage through the State of Illinois Health Insurance Exchange (Marketplace). Subsidies will be based on the cost of a Silver Plan of coverage and if an applicant wants to take a higher level of coverage than the applicant will pay the additional cost and receive subsidy based on the premium value of the Silver Plan.

What is a Silver Plan? A Silver Plan has a individual deductible of $2,000 with 70% coverage after the deductible and a maximum out-of-pocket (deductible and cost share) of $6,350 and double for a family. You would pay 30% after the deductible and once $4,350 is spent at 30% the plan will begin 100% payment. This is the base structure and it is not known if this plan will have office visit copay's or prescription drug copay's. There may be plans in the Marketplace with or without copay's with a lower premium for the plan without. This will be known on 10/1...may a a couple weeks earlier.

To figure out where your income places you in the FPL please follow the below link and then revert back to this post.
http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html

Now...each state is going to have different premiums which will be set by the insurance carrier, however, if you fall within 400% of the FPL, there are guidelines that must be followed, such as to how much you and your family can spend in premiums.

For those that fall within 0-133% of the FPL, there will not a premium to pay as this qualifies for Medicaid or a plan can be purchased on the Marketplace to not exceed 2% of MAGI.

For those that fall within 134-150% of the FPL, premiums must not exceed 3-4% of MAGI.

For those that fall within 151-200% of the FPL, premiums must not exceed 4.1-6.3% of MAGI.

For those that fall within 200-250% of the FPL, premiums must not exceed 6.4-8.05% of MAGI.

With the above FPL percentages, there will be assistance with covering a percentage of out-of-pocket costs such as deductibles and coinsurance and lower copay's.

Those at 251%-400% of the FPL will not be eligible for assistance with out-of-pocket expenses.

For those that fall within 251-300% of the FPL, premiums must not exceed 8.64-9.5% of MAGI.

For those that fall within 301-400% of the FPL, premiums must not exceed 9.5% of MAGI.

So....if you are a individual that has a MAGI of $37,500, your monthly premium shall not exceed $297, and if the premium is higher than $297 you will then receive a premium subsidy to lower your premium share down to $297. If the monthly premium happens to be lower than $297, than there will not be any subsidy as the plan falls within 9.5% of your MAGI. This example would work out the same for one that is 27 years of age and for one that is 50 years of age.

I hope that this post has been informative and is really a guideline to how the system will work when it comes to premiums. Please send a message at any time with questions.

Thanks!

Jordan

FAQ's on 2014 and reform

It has been a long time since I blogged, and I apologize.  Still just myself at the shoppe and have been extremely tied up servicing clients.

For those with any questions on deductibles, out-of-pockets, and preventative care benefits....the below link is great for answering any questions you may have.

10 more months to go!!!

http://www.dol.gov/ebsa/faqs/faq-aca12.html


-The Shoppe