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Affordable Texas health insurance  Texas health reform   Texas Premium Subsidy

Texas Consumers Hit It Big with the Premium Subsidy

Did you know that beginning January 1, 2014, the government may help pay your monthly healthcare premium?  

Millions of Texas consumers who qualify will be eligible for premium assistance as part of the Affordable Care Act (ACA). Individuals and families who meet defined income requirements will be able to receive premium subsidies and financial assistance for out-of-pocket expenses.  So pay attention, in case you fall into one of those categories!
The goal of the subsidies is to help consumers who cannot access affordable coverage either from employers or from the private insurance market by having the federal government pick up some of the tab.

A premium subsidy program was created to increase the number of individuals covered, especially those for whom health insurance was previously too expensive.

Your Family Income Determines How Much Assistance Is Available

In order to be eligible for the subsidies and assistance with out-of-pocket expenses, an individual's or family's gross income will be compared to the federal poverty level (FPL). The level of assistance will be determined by the percentage of gross income to the FPL as determined by the number of family members.
For example, the 2012 FPL is $11,170 for a one-person household and rises by $3,960 for each additional family member.  Therefore, the FPL for a four-person family would be $23,050.  The FPL benchmark will be adjusted for inflation each year, so we will see these amounts increase in 2014.
Subsidies will be available according to ACA rules for individuals and families with incomes ranging from 100% to 400% of the FPL.

The subsidies will be used to reduce the premium cost for health insurance coverage offered within the health insurance marketplaces. Also, financial assistance will be available for out-of-pocket healthcare expenses for those with incomes ranging from 100% to 250% of the FPL. Examples of these out-of-pocket costs include copays and deductibles that would typically be the responsibility of the policyholder.
Contact Stateside so that we can do the math together.  

We'll determine where you and your family fall in relation to the federal poverty level, and whether you qualify for subsidies.

Subsidy Only Available For Plans Offered Within the Marketplaces

Health insurance plans offered in the new insurance marketplaces will consist of four levels of coverage designated as 'metallic plans' for their names - platinum, gold, silver, and bronze.

Each plan has a different actuarial value, which is the percentage of costs each plan will cover.

For example, platinum plans will have an actuarial value of 90%, which means the plan will cover 90% of healthcare costs, and the remaining 10% will be the responsibility of the insured.

Gold plans will provide an actuarial value of 80%, silver plans 70% and bronze 60%. (Note that the bronze plan is excluded from subsidies and assistance for out-of-pocket expenses.)
The premium for the silver plan will establish the level at which subsidies will be accessed. Since healthcare costs vary from state to state, silver premiums will also vary depending on the state. The percentage of premium paid by the insured will be tied directly to the individual's actual income as a percentage of the FPL. For example, individuals and families with incomes at 133% of the FPL will be required to pay 2% of their income toward the health insurance premium.  

Call us so that we can determine what your percentages may be.

Where Does Your Current Income Fall?

The following is the FPL calculated by the number of family members and a list of FPL percentages with the corresponding percentage of income that the policyholder must pay for health insurance premium.
 

Persons In Family

Texas FPL (100%)

1

$11,170

2

$15,130

3

$19,090

4

$23,050

5

$27,010

6

$30,970

7

$34,930

8

$38,890

Each Additional Person Add

$3,960



 

Income Level

Annual Premium Not To Exceed Percentage of Income

Up to 133% FPL

2% of income

133 to 150% FPL

3 to 4% of income

150% to 200% FPL

4 to 6.3% of income

200 to 250% FPL

6.3% to 8.05% of income

250 to 300% of FPL

8.05% to 9.5% of income

300% to 400% FPL

9.5% of income

If you'd like to know more, keep reading.

We realize how confusing this information may feel, and we encourage you to call us to talk through the specifics that matter to you.

What the Subsidy Actually Means In Dollars & Cents

Let's illustrate the premium cost for a family of three...
Assume a family of three has a total income of $38,180. The FPL for a family of three is $19,090. Their income is twice that amount, which places them at them at 200% of the FPL. Therefore, the family would be required to pay 6.3% of their income or $2,405 towards the premium cost of their plan.

The family can purchase any plan available from the marketplace, excluding the bronze plan.  Using the silver plan premium of $12,000 as the benchmark, the premium paid by the family would be $2,405 - for the year - and the remaining $9,595 would be covered by the government as a subsidy.
In addition to assistance with premiums, financial support for out-of-pocket expenses such as copays and deductibles are available to individuals and families whose incomes do not exceed 250% of the FPL.

In order to qualify for financial support, the individual or family will be required to purchase at least a silver plan within the marketplace. The amount paid by the insured for out-of-pocket expenses is based on a scale from 6% of out-of-pocket expenses for the lowest income levels up to 27% of out-of-pocket expenses for income levels up to 250% of the FPL.

How Much Will the Subsidy Save You?

The Congressional Budget Office estimates that a combination of the two benefits - premium subsidy and out-of-pocket expense assistance - will result in an average subsidy of $5,000 a year for individuals and families participating. Benefits will be much higher for families with lower incomes or several children.
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If Your Income
Is In This Range

Current Years Estimate; All those that file together on one 1040 tax form:


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3 People $20k - $79k
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