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Fri, June 05

Obamacare shopping is trickier than ever — here’s a cheat sheet

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WILLIAMS — Health care is complicated. Shopping for an individual health plan just got even more so, with President Donald Trump’s decision last month to block $7 billion in Affordable Care Act subsidies.

Known as cost-sharing reduction payments (CSRs), these federal funds had helped insurers offset the costs of the discounts they are required to offer to some lower-earning customers to help them pay for deductibles and copays.

We’ll spare you the details. But because of how state regulators responded to the chaos and how insurers are trying to recover the money through higher premiums, common-sense rules of shopping may no longer apply.

A high-coverage “gold” plan in many states might now be cheaper than a medium-coverage silver plan.

Experts’ advice, in brief, is: shop around. Play with different options on or state marketplaces. Don’t just renew this year’s plan. For 2018, that might not be the best deal. You may be able to use the following guidelines to help determine the best deal:

Option #1

Your household income is $12,060 to $30,150 for an individual, $16,240 to $40,600 for a couple and $24,600 to $61,500 for a family of four.

By law, insurers still must pass along the cost-sharing reductions, even though the president cut off the reimbursement. And you are probably eligible for them.

To qualify for the cost-sharing reductions, which lower deductibles and copays, you must purchase a silver plan on the marketplace. Those buying other levels — the more comprehensive gold or platinum plans or less generous bronze plan — cannot get this benefit.

However, if you’re healthy and at the lower end of these income ranges, a bronze plan might make the most sense.That’s because of the other Obamacare subsidy, which reduces premiums.

These subsidies are paid directly to qualifying consumers in the form of tax credits. The premium subsidy is so generous for 2018 that, for many people, they could cover the entire cost of bronze plans.

Cost-sharing reductions help only if you expect to pay out-of-pocket costs for doctors and hospitals. If you don’t — and if you feel like gambling that you won’t need expensive care — a free or inexpensive bronze plan might be better.

At the lower ranges of this income group, you might be eligible instead for Medicaid — in states that expanded that program under the ACA.

Option #2

Your household income is between $30,150 and $48,240 for individuals, $40,600 and $64,960 for a couple and $61,500 and $98,400 for a family of four.

You’re eligible for subsidies to reduce premiums, but not the cost-sharing reductions. Even so, the decision to cut them may affect you — in a good way.

To recover the missing $7 billion, most insurers are raising premiums for silver plans by an estimated 20 percent.

The good news is that higher premiums don’t hurt most marketplace consumers. Obamacare caps how much eligible consumers are expected to pay for health insurance — even if premiums go to the moon. The federal premium subsidies cover the difference.

The level of premium subsidy you receive is based not just on your income but also on silver plan prices, and now silver premiums are going up a lot. The higher the silver premiums, the more generous the subsidies.

But that subsidy is not limited to use on a silver plan.

Anybody eligible can take those subsidies and shop for any kind of plan on the marketplace. It’s why many consumers could see their premium bills fall in 2018 — in some cases, to zero.

To repeat: Shop around. Shop early. The plan you have now probably won’t be cheapest next year.

Option #3

Your household income is more than $48,240 for individuals, $64,960 for a couple and $98,400 for a family of four.

If this is you, you’re ineligible for any Obamacare subsidies. That means your chances of getting slammed by premium increases for 2018 are high. Silver plan premiums can climb by 35 percent or more because of high claims and the end of cost-sharing reimbursement to insurers.

But there are ways to limit the pain. Generally avoid silver plans and look at bronze and gold. Those premiums are probably rising less.

However, California and about a dozen other states allowed insurers to sell a separate class of silver plans without the cost-sharing money built into premiums. These may be available only outside the official, online ACA marketplaces, so to find them you have to ask a broker or check websites of insurers or online brokers such as eHealth or GetInsured.

Option #4

Your household income is less than $16,643 for an individual, $22,411 for a couple and $33,948 for a family of four.

You may qualify for Medicaid, the federal and state health program.

Editor’s note: Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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