Which Health Plans Qualify For A Subsidy?

We've already discussed how millions of people will be eligible for billions in health subsidies effective Jan 1st, 2014.   A common question then arises from our visitors...which plans will be eligible for these subsidies?  Great question because not every plan will be eligible for the subsidy, and in fact, there may only be one plan that is designated as subsidy eligible.  Let's find out which plan makes the grade since it can dictate $1000's of dollars you may miss if on the wrong plan.

Quick intro to the new Health Exchange

First, we need to understand that there are two marketplaces and only one will have the subsidy available within.  There will be new Health Exchanges available in each State.  Some States are operating their own Exchange while others will allow the Federal Exchange to operate for their State.  Either way, it's a separate marketplace designed to allow the purchase of health insurance on a subsidized basis for those eligible based on income.  There may also be plans available outside this Exchange but they will have the same general benefits and pricing (provider networks may be different) and they will not be eligible for the subsidy.  You will be able to quote both options (with subsidies included if eligible) through our Health insurance quoting page starting October 1st, 2013.  The net take-away is this, only the Exchange plans will offer one that is eligible for the subsidy.  So which plan is that?

The Silver health plan reigns supreme in the Exchange

The ACA law specifically states which plan is eligible for the subsidy and it's the Silver health plan (out of Metallic options:  Platinum, Gold, Silver, and Bronze).  The law also stated that people making under 250% of Federal Poverty Level will be eligible for an additional benefit subsidy (improved health benefits and cost sharing) and different States may go about this in different ways.  For example, a State may have different versions of the Silver health plans based on income levels (150-200%, 200-250%, 250-400%) etc.  They may also kick up the benefits to the Gold or Platinum but at the same cost of the Silver plan.  Either way, our system will automatically show you your premium amount based on both any eligible subsidies and benefit improvements.  You will not need to deal with complexity behind the scenes as the best possible rate/plan will be shown to you based on your entered age, area, and income information.  In general, the Silver plan is the only plan eligible for the health subsidy and it must be purchased from within an Exchange which you can access directly through our Silver Plan Quote page. 

Why the Silver plan is the only plan eligible for health subsidy?

Keep in mind that eligibility is based on income (up to 400% of poverty) so the Silver plans was designated as the middle group between expensive health premiums (Platinum and Gold) and expensive out of pocket medical cost-sharing (think Bronze or Catastrophic plan for young adults).  The Silver was deemed as the plan that was most affordable in this contrast between premium and cost-sharing and therefore became the lucky target for subsidies.  We expect the overwhelming number of applicant purchasing coverage within the Exchange will go with the Silver for this reason.  Otherwise, people (not eligible for the subsidy) will likely look at the Bronze plan out of the Exchange.

 

 

 



Los Angeles, Family of 4
making $60K.
  Subsidy=$8,388*


Iowa, Single Adult making $30K
Subsidy=$4,222*

*Based on age, expected costs, and other assumptions according to Kaiser Calculator.  Actual subsidies will vary and official subsidy amounts will be available Oct 1st, 2013. 


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