Does the calculator provide definitive estimates of what people will pay under the health reform law?
No. The calculator is intended to illustrate how families in varying circumstances may be affected by the tax credits and limits on age rating included in the law. Premiums will vary from region to region and based on assumptions insurers make in setting premiums. In addition to what people would pay in premiums, they would also have out-of-pocket expenses for cost sharing (e.g., deductibles and coinsurance), which in some cases would be subsidized based on income. In addition, there are many other factors that could increase or decrease how much people pay, including efforts to make the health care system more efficient and additional revenue measures to finance the federal cost of reform.
So take the numbers with a grain of salt. However, assuming the resulting numbers are at least in the ballpark, this is very helpful and, for me, reassuring . If the calculator is correct then, in New Jersey, my annual premium for a Silver plan is going to be about what I’m paying now. I would have to see one-to-one comparisons of co-pays, deductibles, and maximum out-of-pocket numbers; and I would have to see how limited the in-network pool of providers is to determine if the plans are comparable; but at least I can relax about having to spend a gazillion dollars more than I’m spending now to get some kind of coverage.*
It’s interesting to use the calculator to play around with different income levels and see what happens. My premium is always $8,093 but subsidies change - sometimes a lot - and Medicaid eligibility adds another wrinkle.
If I enter my income as $46,000, my subsidy is $0; I pay $8.093.
If I enter my income as $45,000, my subsidy is $3,818; I pay $4,275. Making $1000 less saves me almost $4000 in health insurance costs.
If I enter my income as $44,000, my subsidy is $3,913; I pay $4,180. Now making $1000 less saves me less than $100 in health insurance costs.
If I enter my income as $34,000, my subsidy is $4,903; I pay $3,109. Making $10,000 less saves me $1,010 in health insurance costs.
If I enter my income as $24,000, my subsidy is $6,507; I pay $1,587. Making $10,000 less saves me about $1,600 in health insurance costs.
If I enter my income as $14,000, my subsidy is $7,813; I pay $280. Making $10,000 less saves me about $1,300 in health insurance costs.
At this level, I’ve started getting Medicaid notices:
If my State expands Medicaid to everyone under 138% of the poverty level, I can go into Medicaid.
If my State doesn’t expand Medicaid to everyone under 138% of the poverty level, I can buy subsidized coverage through the exchanges.
I assume (although it is not said explicitly) that if my State expands Medicaid, I can still buy coverage through the exchanges but
i will not be subsidized. I’ll be too poor for subsidies.
If I enter my income as $4,000, my subsidy is $0; I pay $8,093. Making $10,000 less costs me $7,813 in health insurance costs.
It’s not that simple, of course. The problem here is that my annual income is below 100% of the federal poverty level. That means I either go into Medicaid (if my State allows it) or I buy an unsubsidized policy through the exchanges. There is apparently no scenario in which I can buy subsidized coverage through the exchanges. I’m really too poor for subsidies.
The calculator also sometimes informs me that:
Because Bronze level coverage would cost more than 8% of your household income, you may instead opt to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing ($6,350 in 2014). However, preventive services are covered with no cost sharing required.
As far as I can tell, I start getting this message once I report an income below 100% of the poverty line. I had heard that only young people could buy catastrophic** coverage but according to the “Notes” section below the calculator:
The law also makes available a catastrophic policy for young adults and those exempted from the requirement to obtain insurance due to affordability. Catastrophic plans are less comprehensive and have a lower premium than other coverage. Eligibility to purchase catastrophic coverage is reflected in the calculator, when applicable. Premium subsidies may not be applied to catastrophic coverage.
So a very useful tool, both for me personally and for beginning to understand how this is all supposed to work. Thanks, Kaiser.
* I do still have to worry about whether I can get into the exchanges to register and about whether I'm willing to give the government all that information. Sometime next week I'll talk to Blue Cross/Blue Shield about whether I can buy direct from them and skip the online exchanges.
** Catastrophic-ish actually. My understanding is that even the "catastrophic" policies pay for some preventive care.