Ad-Express and Daily Iowegian, Centerville, IA

December 17, 2013

Closer look at ACA costs

By Michael Schaffer Managing Editor
The Daily Iowegian

---- — Looking for health care insurance? Have you tried any of the online health insurance exchanges, or “Marketplaces,” like HealthCare.gov or www.insurancemarketplace.org?

If you have, the options can be mind boggling.

For instance, www.insurancemarketplace.org, Iowa’s state-federal partnership exchange, which basically means that it is set up with the federal marketplace, but run by the state of Iowa, offers three different plan levels — Gold, Silver and Bronze — with each level offering more or less coverage.

If you go to www.insurancemarketplace.org and click on a tab at the top labeled “Cost Center” you will be directed to a “Subsidy Calculator,” which allows a person to enter income level, age, family size and other information to see an estimate of ones eligibility for a subsidy and how much a person would pay for the Silver health care insurance plan.

The cost calculator is a tool developed by the Kaiser Family Foundation at www.insurancemarketplace.org and illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges or “Marketplaces” created by the Affordable Care Act.

If an individual age 30 enters one adult looking for coverage with one person in the family the health insurance premium in 2014 is $2,814 per year for incomes from $20,000 and up. However, as the income increases the government tax credit subsidy decreases: At $20,000 the subsidy is $1,792; at $30,000 the subsidy is $302; at $40,000 and up the subsidy is zero.

If an individual age 30 enters one adult looking for coverage with two people in the family the health insurance premium in 2014 is $2,814 per year for incomes from $30,000 and up. At $20,000, the two-member family is eligible for Medicaid. The subsidy at $30,000 is $1,014; at $40,000 and up the subsidy is zero.

If an individual age 30 enters one adult looking for coverage with three people in the family the health insurance premium in 2014 is $2,814 per year for incomes from $30,000-$50,000. At $20,000, the three-member family is eligible for Medicaid. The subsidy at $30,000 is $1,564; at $40,000 it is $226 and at $50,000 and up the subsidy is zero.

If an individual age 30 enters one adult looking for coverage with four people in the family the health insurance premium in 2014 is $2,814 per year for incomes from $40,000 and up. At $20,000-$30,000, the four-member family is eligible for Medicaid. The subsidy at $40,000 is $848 and at $50,000 and up the subsidy is zero.

If two individuals age 30 enter looking for coverage with four people in the family the health insurance premium in 2014 is $5,627 per year for incomes from $40,000 and up. At $20,000-$30,000, the four-member family is eligible for Medicaid. The subsidy at $40,000 is $3,662; at $50,000 the subsidy is $2,262; at $60,000 the subsidy is $714 and at $70,000 and up the subsidy is zero.

A couple of things to think about.

If you use tobacco, in most states insurers can charge a tobacco surcharge of up to 50 percent of your total premium before the tax subsidy.

If your employer offers health care insurance you probably are not eligible for a tax subsidy. However, you might be eligible for a subsidy if the health care plan through your employer requires you to spend more than 9.5 percent of household income on the insurance premium or the plan does not meet the minimum standards of ACA.

And if you go to HealthCare.gov to look for health care insurance be prepared for even more options.

One thing you will find there is a chart with levels of income and household member numbers to show if an applicant may qualify for lower premiums through a subsidy and lower out-of-pocket costs for a “Marketplace” insurance plan and if you qualify for Medicaid.

The site allows a person to answer a few questions like age, state where living and number of people seeking insurance.

If you plug in Iowa, Appanoose County, age 55 and one person seeking insurance, you’ll get 26 different health care plans with premiums ranging from $357 to $742 per month, deductibles range from $500 to $6,350 per year and out-of-pocket costs ranging from $1,000 to $6,350 per year.

Iowa was one state that opted to expand their Medicaid coverage under the ACA giving low-income Iowans access to health care insurance.

Iowa’s Community Health Centers estimate the expanded Medicaid in Iowa will cover more than 150,000 low-income Iowans beginning Jan. 1.

In states that opt out of expanding Medicaid, some people making below $33,000 for a family of four will still be eligible for Medicaid, some will be eligible for subsidized coverage through Marketplaces, and others will not be eligible for subsidies.

The first story in this series directed consumers to a local health care provider to sign up for health care insurance. The third part of this series will look at the ACA and it’s real-life impact.