Many Americans will be able to buy health insurance through their State’s marketplace with the help of Premium Assistance Payments, also known as subsidies. These payments are only offered through the marketplace and help reduce premium costs and lower out-of-pocket expenses.
The Affordable Care Act's subsidies are aimed at people with incomes between 139% and 400% of the Federal Poverty Level (FPL). The FPL changes each year, adjusted for inflation. Currently 139% of the FPL is $23,050 for a family of four and 400% of the FPL is $92,200. Families whose incomes fall between 139% and 400% FPL will be eligible for subsidies. But, the more you make the less cost assistance you will receive.
Doing all of the math involved in determining what your premium and assistance amounts would be is complicated. To make things easier we have provided access to the Kaiser Family Foundation's Premium Assistance Calculator. Just enter a small amount of information and, presto, you have a very close idea of how much assistance you will receive and an explanation of how the number was calculated.
Premium Assistance Payments are given as refundable tax credits, either when you file your taxes or in advance if you request and qualify for it. Be aware, however, that if you choose to take the credits in advance and your income or family situation changes in a way to increase your income under the rules, you could end up owing the government money at the end of the year.
If you look closely, you realize that there is a gap between 100% and 139% of the FPL where you could end up not qualifying for Premium Assistance Payments and also not qualifying for government provided health care such as Medicaid. Originally the plan was to require all of the states to raise the eligibility for public assistance to 138% of the FPL, with the Federal Government providing grants for the first few years to cover the additional costs. The U.S. Supreme Court, however, decided that the states could not be forced to change the eligibility requirements, and many decided not to, including Louisiana. This means that if you fall between 100% and 139% of the FPL you qualify for neither public assistance health care nor the Premium Assistance Payments, and are left on your own to pay the full price for your health insurance. The only positive point here is that you would not be subject to the Shared Responsibility Payment requirement if you fail to purchase health insurance.
If you still have questions after reading this information and using the Premium Assistance Calculator, call us at (504) 441-7283 to speak to a Dan Burghardt Health Insurance Specialist. We'll be happy to assist you in determining exactly how much assistance you qualify for and what you could save on your health insurance.