2017 Subsidy and Cost-Sharing Guidelines
for Marketplace Health Insurance plans
Percent of Federal Poverty Level (FPL)
. 100% 133% 150% 200% 300% 400%
1 $11,880 $15,800 $17,820 $23,760 $35,640 $47,520
2 $16,020 $21,307 $24,030 $32,040 $48,060 $64,080
3 $20,160 $26,813 $30,240 $40,320 $60,480 $80,640
4 $24,300 $32,319 $36,450 $48,600 $72,900 $97,200
5 $28,440 $37,825 $42,660 $56,880 $85,320 $113,760
6 $32,580 $43,331 $48,870 $65,160 $97,740 $130,320
For each additional person, add
. $4,160 $5,533 $6,240 $8,320 $12,480 $16,640
|If you earn||Your expected contribution is|
|Up to 133% of FPL||2.04% of your income|
|133%-150% of FPL||3.06%-4.08% of your income|
|150%-200% of FPL||4.08%-6.43% of your income|
|200%-250% of FPL||6.43%-8.21% of your income|
|250%-300% of FPL||8.21%-9.69% of your income|
|300%-400% of FPL||9.69% of your income|
How out-of-pocket savings work?
If you qualify for savings on out-of-pocket costs and enroll in Silver plan:
You’ll have a lower deductible. This means the insurance plan starts to pay its share of your medical costs sooner. For example, if a particular Silver plan has a $750 deductible, you have to pay the first $750 of medical care yourself before the insurance company pays anything (other than free preventive services). But if you qualify for extra savings your deductible for a Silver plan could be $300 or $500, depending on your income.
You’ll have lower copayments or coinsurance. These are the payments you make each time you get care – like $30 for a doctor visit. If a Silver plan’s copayment is $30 for a doctor’s visit, if you enroll in the plan and qualify for extra savings, you may pay $20 or $15 instead.
You’ll have a lower “out-of-pocket maximum.” This means the total amount you’d have to pay in a year if you used a lot of care, like if you got seriously sick or had an accident, will be lower. Instead of $5,000, your out-of-pocket maximum for a particular Silver plan could be $3,000.
|How Does the Cost-Sharing Reduction Level Affect Cost-Sharing Charges?|
|Standard Silver – No CSR||CSR Plan for 201-250% FPL
|CSR Plan for 151-200% FPL
|CSR Plan for up to 150% FPL
(up to $17,235)
|Actuarial Value||70% AV||73% AV||87% AV||94% AV|
|Maximum OOP Limit (Individual)||$5,500||$4,000||$2,000||$1,000|
What exactly is The Affordable Care Act also commonly referred to as “Obamacare”?
The “Patient Protection and Affordable Care Act,” commonly known as PPACA, was first introduced as a measure to deal with rising healthcare costs and numbers of uninsured.
The heart of PPACA consists of three provisions: guaranteed issue (insurers must offer coverage regardless of the applicant’s health status or pre-existing conditions), community rating (insurers must offer policies within a given territory at the same price regardless of health status, age, gender, or other factors), and an individual mandate. The individual mandate assures that everyone has a minimum amount of coverage: those above a certain annual income are required to purchase coverage or incur a tax penalty; those who cannot afford it will have their coverage paid for by the government.
What are the income guidelines for 2015 to qualify for lower premiums?
What are the tax penalties for not purchasing a plan that qualifies as minimum essential care?
Taxes begin in 2014 and rise in years following. In each year, the tax consists of the higher of a dollar amount or a percentage of household income. For a given household, the tax applies to each individual, up to a maximum of three. Following is the schedule of taxes:
- 2014: The higher of $95 per person (up to 3 people, or $285) OR 1.0% of taxable income.
- 2015: The higher of $325 per person (up to 3 people, or $975) OR 2.0% of taxable income.
- 2016: The higher of $695 per person (up to 3 people, or $2,085) OR 2.5% of taxable income.
- After 2016: The same as 2016, but adjusted annually for cost-of-living increases.
2014 – family of 2; taxable income = $26,000;
tax = $260 because $260 ($26,000 x 1%) is higher than $190 ($95 x 2 persons).
2014 – family of 3; taxable income = $26,000;
tax = $285 because $285 ($95 x 3 persons) is higher than $260 ($26,000 x 1%).
Calculate what your penalty would be if you don’t enroll in a plan that meets the minimum required coverage with this new ACA Penalty Calculator
Will my insurance cover me when I travel out of state?
Perhaps. This is an important question to research. For example, currently the Georgia exchange Blue Cross Blue Shield products are all an “Open HMO” which means that you can go to any BCBS HMO provider or specialist without a referral and without having to select a primary care physician. However, when you are out of state, you will only have emergency and urgent care coverage. Non-emergency treatment will have to be paid 100% out of pocket.
Are off exchange plans also available to people with pre-existing conditions.
Yes, in most circumstances they are offered guaranteed issue. Learn more.
Is maternity covered on both in exchange and off exchange insurance plans?
Yes, as part of the Affordable Care Act, every insurance policy must include maternity coverage, even if that benefit will never be used. You should consult the plan for details.
If I purchase an insurance plan outside the exchange, will I be eligible for the government subsidy?
I’m uncertain about my projected income for the year. What happens if I miscalculate my estimated earnings for 2014?
You will make adjustments when you file your federal tax return.
What if my situation changes and I become unemployed?
If your situation changes and you are no longer eligible for the Marketplace Exchange program because you would qualify for Medicaid, you would being Medicaid coverage on January 1st of the following year. If your actual income was below the poverty level of your area, there is the possibility that the subsidy received could be recaptured when you file for your Federal tax return. If find yourself in that situation, it may be necessary to contact your local Social Security office to apply for a hardship exemption which is reviewed on a case-by-case situation.
How can I make my first payment?
Blue Cross Blue Shield of Georgia has set up a website to process your first payment. Click here to make your Blue Cross Blue Shield payment.
Or you you can call customer service at 1-855-738-6652.
What if I have job-based coverage? Can I shop for an individual plan?
If you decide to check out Marketplace plans, be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise.
Whether you qualify for lower costs based on your income will depend on the coverage the employer offers. You won’t be able to get lower costs if your job-based coverage is considered affordable and meets minimum value.
Employer coverage is considered affordable – as it relates to the Advanced Premium Tax Credit (APTC) – if the employee’s share of the annual premium for self-only coverage is no greater than 9.5% of annual household income. Starting in 2014, individuals offered employer-sponsored coverage that’s affordable and provides minimum value won’t be eligible for a premium tax credit.
The employer can tell you whether the insurance plan it offers meets minimum value. It can provide you with information to determine if the plan is considered affordable to you.
One way to gather this information is by asking your employer to fill out an Employer Coverage Tool.
How do I to go to the doctor or fill a prescription if I haven’t received my new insurance card?
Even though you haven’t received your insurance card, your coverage may be effective. If you need to see a doctor or get a prescription filled before you get your insurance card, call your insurer to make sure you have coverage. You also can ask them to confirm your enrollment for your doctor or pharmacy so they can provide you care at the cost set by the health plan.
If you don’t have an insurance card, you can find this number on the insurer’s website, by logging in to the Marketplace at www.healthcare.gov or by calling the Marketplace Call Center at 1-800-318-2596 where a trained representative can help you find it.
BLUE CROSS BLUE SHIELD OF GEORGIA 1-855-738-6652