Obamacare News Blog

ACA Subsidies: Think You Qualify? Think Again

Many Americans are going to be surprised that they don’t qualify for subsidies even though their income falls within federal eligibility standards. The reason for this is subsidies are not just based off of income, but rather age and region act as qualifying factors as well.

Affordable Care Act Subsidies

There are two types of subsidies available to Americans enrolling in the new Health Insurance Marketplace Bronze, Silver, Gold, or Platinum plans:

• Federal Premium Subsidies: To help with the monthly costs
• Federal Cost-Sharing Subsidies: To help with copays, deductibles, and coinsurance

What are the Eligibility Requirements for ACA Subsidies

You may qualify for premium subsidies if you make between $11,490 and $45,960 per year. To qualify for cost-sharing subsidies you must make between $11,490 and $28,725. These are the basic perimeters of the qualifications, but there are other factors in play as well, as stated above: age and region.

Why You Won’t Qualify for Premium Subsidies

Covered California has released its plans and what the premium and cost-sharing subsidies would be available for individuals. For instance if you live in Los Angeles, are 26 and make $30,000 a year or 35 and make $35,000, you will not receive any premium subsidy help even though you fall under the “eligibility” set out by the Affordable Care Act.

Why is this? According to Covered CA, “For your income, age, and location, the cost of health insurance is below the “fair share” amount called for under the Affordable Care Act. This means you will pay less for coverage than people living in areas with higher insurance costs or people who have higher costs due to their age.”

Don’t Qualify for Subsidies? Buy an Off-Exchange Plan

Many people don’t realize that on-Exchange plans aren’t the only plans in play. Insurance providers may offer identical plans off the Exchange or providers may offer plans that have added benefits. Remember all plans after 2014 (with the exclusion of grandfathered plans) must include the ObamaCare essential health benefits which include $0 preventive care, mental health, ambulatory services, and pediatric dental and vision. So you won’t be exchanging quality when choosing an off-Exchange plan.

Why to Choose an Off-Exchange Plan

If you qualify for subsidies, don’t purchase off the Exchange, but if you don’t qualify, purchasing off-Exchange plans saves you time and protects your privacy by not having to reveal personal financial information such as assets, alimony, and child support. Remember agents can help you learn if you qualify for subsidies and help you sign up for on or off-Exchange plans.

For further questions about whether you qualify for subsidies call 800-930-7956 or contact Medicoverage.