Quick answer. Yes for certain individuals. Individuals with income at 400% of the Federal Poverty Level (FPL) and below (about $46,000 for single and $94,000 for a family of four) will be eligible for what I call premium support and thus will pay a lower rate.
How do they apply? On October 1st when the Open Enrollment period begins for coverage starting January 1, 2014 individuals can apply for help. Applications can be placed through Connecticut’s Health Insurance Marketplace’s online enrollment site or by calling a 1 800 number when the Open Enrollment period begins Oct. 1st for coverage starting January 1, 2014. Connecticut’s Marketplace is operating with the name Access Health CT.
I am pleased to share these points on the current regulations implementing federal health reform, what they say on eligibility, and how this new program to apply for help will work:
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● Eligibility is based on a person’s modified adjusted income (MAGI) and what percent of the FPL it is. Individuals whose income ranges from 400% of FPL down to 138% will be eligible for this special help.
● An example: The share of their premium a single person making $40,000 will have to pay is an amount equal to 9.5% of their annual MAGI or $316.66 a month. The monthly share for a family of four whose MAGI is $94,200 would be $745.75.
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Note: The share of premium, a person 22 and one who is 62, will pay is the same if each has the same income.
● How is the amount of help determined? It’s calculated by subtracting, for example, the above Single individual’s $316 share from their premium. If the age based premium was $600 their premium support would be $284. Technically the help a person qualifies for is an Advance Premium Tax Credit (APTC) and as a tax credit it will be reported to the IRS. Thus, a person will be responsible to reconcile this credit as part of their annual 1040 income tax report.
● This help or APTC amount is not based on the plan a person may select but on the monthly premium of the second lowest cost Silver plan for their age. Some details on the coverage the new plans will have can be found in my Aug. 11th post.
● The federal Health and Human Services agency will send the individual's premium support to the medical insurance company they selected. The amount companies receive each month will vary since the premium for different ages and number of individuals covered are different.
● The health insurance company will then invoice them at home each month for their share, which is the balance of their premium, and they will pay this with personal funds on an after tax basis.
Initial plans for the application process were for a person to go to Access Health CT, enter personal and financial information, and while this was being done the system would:
● Interact through a federal level data hub with federal agencies, such as Homeland Security (citizenship), Social Security, and the IRS.
● Come back to them in real time and indicate, while still on line, if eligible for help and the amount they would have to pay each month. e.g. the above $316.
● Move them to the next step to review medical insurance plans from the three companies offering plans on the Individual part of Access Health CT. Eligible individuals will be able to select a plan, other than the second lowest cost Silver plan by paying the additional premium.
● Then move them to the medical insurance company they selected to complete their enrollment.
One of the initial questions a person will have to answer in the application for help will be - do they currently have medical insurance from their employer? If so and if their share of the companies premium for their coverage meets an affordability and coverage standard they will not be eligible for premium support.
As of August 14th we do not know how much of the fully automated enrollment process will be available initially.
Want to take a look at whether you would be eligible for a premium discount and what your share might be? Go to AccessHealthCT.com There is a link to a savings calculator on the home page.
John C Parker, RHU, LTCP
Niantic CT
