Healthcare Reform – Did You Know?

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Healthcare Reform

Healthcare Reform (ACA) is not as simple as 1, 2, 3. Many people have questions. Not all situations are alike and truly what is good for your friend may be not be good at all for you.

Some of the questions people are asking about Obamacare are;

Question: My income qualifies me for a subsidy (or tax credit). My employer offers group insurance. Can I apply for an ACA plan on the exchange and get this better rate?

Answer: No, if your employer offers a group health plan this is affordable, which means it costs you for employee coverage less than 9 ½ of your income; and has minimum essential benefits; then you cannot get a subsidy.

Question: I have a family. Our household income qualifies us for a subsidy (or tax credit). My employer offers group insurance for both me and my family. My costs are low, but the cost for my family is expensive. Can I have my group plan and enroll my family through the exchange for an ACA plan and use a subsidy to get this better rate?

Answer: No, regardless of dependent costs, if your employer offers dependent coverage you cannot get a subsidy.

Question: I have a family of 4. How much money could our household earn (Modified Adjusted Gross Income, MAGI)?

Answer: $94,200.00 MAGI

Question: Our MAGI income qualifies us for a subsidy and we do not have a group plan available, can I use my agent or an insurance agent to help me?

Answer: Yes, if the agent is ACA certified.

Question: I am age 63 and have $750,000 in assets, but my income is below 138% of Federal Poverty Level (FPL). If I apply on the exchange what would happen?

Answer: Because of your limited income, your application will, most likely, be sent to the State Public Aid. They will decide if you would be covered by Medicaid or can enroll in a plan. However, because you have the lower income you cannot receive a subsidy. You may be best served to apply off exchange.

Question: What is off exchange?

Answer: applying directly with the insurance company and not be eligible for cost sharing or subsidies.

Question: What is cost sharing?

Answer: If your MAGI is between 138% – 250% of FPL, you may qualify for subsidies to help you pay premiums. In addition you may be entitled to part of your out of pocket deductible and coinsurance costs to be paid by the government. Paying a portion of your out of pocket costs is called cost sharing.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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