How do I sign up?
Health plans—and subsidies—will be available through separate marketplaces in each state. In 36 states, the federal government is running or helping run these online marketplaces—or exchanges—where consumers can shop for coverage and compare plans, and apply for subsidies. Fourteen states are launching their own exchanges. Starting Oct. 1, people will be able to sign up for coverage that begins effective Jan. 1. The enrollment information for the federally operated marketplaces, including Ohio, will be available at HealthCare.gov. That site will also direct consumers in states like California, New York and Oregon that will be running their own exchanges to those states' websites.
Am I eligible for a premium subsidy?
The health law provides federal subsidies to offset the cost of health insurance for people who don't have access to coverage through their employer or government programs like Medicare or Medicaid. Those who make anywhere between the poverty level and four times that amount are eligible. That's currently between $11,490 and $45,960 for a single person, between $15,510 and $62,040 for a couple, between $19,530 and $78,120 for a family of three, and between $23,550 and $94,200 for a family of four. Wages, unemployment compensation, retirement income and Social Security disability insurance all count as income.
What's the subsidy worth?
Subsidies are based on a formula pegged in part to the price of the second-lowest-cost mid-level (Silver) plan available to a customer in his or her community. The amount varies by income, age and area of the country, and tapers down as income rises. For example, a 50-year-old single person in Toledo earning $22,000 would get a $231 monthly subsidy. If the same 50-year-old earned $40,000, the subsidy would be $23 a month.
Who gets the biggest subsidies?
Because insurers can charge their oldest customers up to three times as much as their youngest, older people can get more valuable subsidies. The second-lowest-cost silver plan for a 25-year-old in Toledo is $191 a month, for instance. A single 25-year-old earning $22,000 would get an $82 subsidy toward that premium. A single 50-year-old would have a monthly premium of $339 for that plan, which is why even though they have the same earnings as the 25-year-old, they would get a subsidy of $231.
What could affect my eligibility?
Changes in family size such as marriage, divorce, another child, or a child moving away all affect how your income is defined relative to the federal poverty level. Changes to your earnings could also affect your eligibility, such as a bonus, overtime, losing hours or a pay cut. Changes to your work benefits package might also matter, because you can't get a subsidy if your employer offers you coverage, unless the premiums for that plan would cost you more than 9.5% of your take-home pay.
How do I use the subsidy?
Subsidies can be used only for health-insurance policies bought through the new health-insurance exchanges in each state. They can be taken upfront and applied toward the cost of a premium each month, or claimed as a tax credit at the end of the year.
What if I end up making more money than I thought I would?
If you're taking your subsidy upfront and you end up making a lot more money than you expected, you'll have to pay some or all of it back when you file your taxes. Consumer groups are advising people to tell their health-insurance exchanges as soon as they have income or family changes that will affect the size of their subsidy or their eligibility for assistance. The exchanges can recalculate their subsidies for coming months. Tax preparers have also advised people who expect income changes, especially toward the end of the calendar year, to consider taking their subsidy in the form of a tax credit at the end of the year, or taking only part of it upfront, so they don't end up with a much bigger-than-expected bill.
What if I end up making less money than I thought I would?
You can get subsidies only for insurance plans bought through the exchange. Tax preparers have said some people may want to consider using the exchanges to buy their health insurance even if they don't expect to get a subsidy. That way, people can apply for subsidies if their incomes drop unexpectedly.
What if I don't buy through the exchange in my state?
It will still be possible to buy health insurance on your own without using the new insurance exchanges, and some carriers are only selling their plans outside the exchanges in 2014. Because most policies will be subject to the new rules included in the federal health law about how rates are calculated and what insurance must cover, plans sold off the exchanges will be priced similarly to plans available on the exchanges.
