MAKING HEALTH CARE MORE AFFORDABLE

Meekins Insurance Service

Making health care more affordable

Subsidies can help

To help make health insurance more affordable and effective, the federal government offers advanced premium tax credits, also called subsidies, to individuals and families who qualify based on their income and household size. These subsidies reduce the monthly cost of a health insurance plan for those who qualify. To qualify for a subsidy under health care reform, you must:

  • Be between 100% and 400% of the federal poverty level (FPL)
  • Not be eligible for public coverage, such as Medicaid, the Children’s Health Insurance Program (CHIP), Medicare or coverage through the armed services
  • Not have access to insurance through an employer (An exception can be made if the employer’s plan doesn’t provide required minimum benefits or if the plan is considered unaffordable – the premium is more than 9.5% of the employee’s income.)

More help

In addition to premium subsidies there are also cost-sharing reductions (CSR), another type of subsidy that provides further help for those between 100% and 250% of the federal poverty level. CSRs can reduce the amounts you pay out-of-pocket − such as money for copayments and deductibles. CSRs are essentially an upgrade of your plan at no additional cost to you.

To qualify for a CSR you must purchase a silver plan. And remember, you don’t have to choose between a premium subsidy and a CSR. If you qualify for a CSR, you can also apply your premium subsidy to the monthly cost of your CSR plan.

Big picture

Overall, subsidies and CSRs can lower health insurance costs significantly for those who qualify based on income. In fact, subsidies can reduce the monthly premium to as low as $19 per month for those who qualify.* So be sure to learn if you qualify. Even a family of four with a household income of as much as $94,200 may be eligible for a subsidy.**

  • The credits are paid directly to your health insurance company – you pay the difference between the full premium and the subsidy on your monthly bill
  • You can use your subsidy on any BCBSNC plan except the catastrophic plan and grandfathered plans (See the following page for more detail on subsidies, CSRs and the metallic levels.)

Who’s eligible for subsidies and cost sharing reductions?

People with incomes:

  • Between 100% and 250% of the Federal Poverty Level (FPL) are eligible for premium tax credit subsidies and cost sharing reductions. Cost sharing reductions require the purchase of a silver level plan or higher.
  • Greater than 400% of the FPL are ineligible for subsidies. People with incomes below 100% of the FPL may be eligible for Medicaid.

Federal Poverty Level (FPL) guidelines**

Household
Size

ANNUAL HOUSEHOLD INCOME

100% FPL

250% FPL

400% FPL

1

$11,490

$28,725

$45,960

2

$15,510

$38,775

$62,040

3

$19,530

$48,825

$78,120

4

$23,550

$58,875

$94,200

5

$27,570

$68,925

$110,280

6

$31,590

$78,975

$126,360

7

$35,610

$89,025

$142,440

8

$39,630

$99,075

$158,520

Each Additonal

+ $4,020

+ $10,050

+ $16,080

* BCBSNC Internal Data; Based on an estimated cost of the second-lowest cost silver plan for a 40 year old at 100% FPL located in Raleigh.

** Source: http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html. These 2013 FPL guidelines are for the 48 contiguous states and Washington D.C.