We’re less than 2 months out from the grand opening (pending any possible delay) of Florida’s health insurance marketplace. Some Marketplace health plans will have lower monthly premiums and may charge you more out of pocket when you need care. Some will be higher-premium plans that cover more of your costs when you need care. Others will fall in between. All plans will cover the same list of essential health benefits.
Starting in October when you use the Marketplace to compare plans or meet with an agent, you’ll see prices for all plans available to you. Prices will show any cost savings you may be eligible for based on your income.
Will I qualify for a subsidy?
It depends on the size of your household and the amount of income you earn every year. The lower your income, the higher your savings will be. In general, people at the following income levels will qualify to save in 2014. (The amounts below are based on 2013 numbers and are likely to be slightly higher in 2014.)
- Up to $45,960 for individuals
- Up to $62,040 for a family of two
- Up to $78,120 for a family of three
- Up to $94,200 for a family of four
- Up to $110,280 for a family of five
- Up to $126,360 for a family of six
- Up to $142,440 for a family of seven
- Up to $158,520 for a family of eight
If you fall within these thresholds, you’ll see the amount of savings you’re eligible for when you fill out your Marketplace application. Prices shown for insurance plans will reflect the lower costs. Keep in mind that prices of Marketplace plans have not been set yet. Prices will be available Oct. 1, 2013, when open enrollment starts and you can begin shopping.
These lower costs are handled with a tax credit called the Advance Premium Tax Credit. But these tax credits can be applied directly to your monthly premiums, so you get the lower costs immediately.
What about my out-of-pocket costs?
When you get coverage through the Marketplace, you may be able to get lower costs on deductibles, copayments and coinsurance as well.
As with the premium tax credits, whether you qualify depends on the size of your household and your annual income. For getting lower out-of-pocket costs, the threshold is lower.
Health insurance companies offering coverage through the Marketplace must lower the amount you pay out of pocket for essential health benefits if your household income is below the following amounts. (Incomes below are based on 2013 numbers. They are likely to be slightly higher in 2014.)
- Up to $28,725 for individuals
- Up to $38,775 for a family of two
- Up to $48,825 for a family of three
- Up to $58,875 for a family of four
- Up to $68,925 for a family of five
- Up to $78,975 for a family of six
- Up to $89,025 for a family of seven
- Up to $99,075 for a family of eight
Plans in the Marketplace are separated into four different categories: Bronze, Silver, Gold and Platinum. These categories are based on how much of your medical costs you pay and how much the plan pays when you get medical care. They are not based on plan quality. If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings.
Just the beginning …
We’ll be digging deeper into the health insurance marketplace as we get closer to its opening, so be sure to save a place on your bookmark bar for us or sign up to receive weekly updates straight to your inbox.