Affordable Health Insurance
- What is affordable health insurance?
- How can I find affordable health insurance?
- Affordable health insurance through your employer
What is affordable health insurance?
Whether a health insurance plan is affordable or not for a consumer depends on both the cost of premiums and out-of-pocket costs. A premium is the amount the beneficiary or their employer must pay before they are covered by a health insurance plan. Generally it is paid on a monthly, quarterly, or yearly basis. Out-of-pocket costs are the expenses that the enrollee pays for their medical costs. Deductibles, copayments, coinsurance, and any other fees that the enrollee pays for covered services fall under the category of out-of-pocket costs.
A deductible is the amount the enrollee owes for covered health care services before the plan begins to pay. Deductibles do not necessarily apply to all services. Coinsurance is the percentage that the enrollee owes for a covered health care service. The plan pays for the remaining percentage. Copayment, also known as copay, is similar to coinsurance except instead of a proportion of costs, it is a fixed amount for a covered health care service.
An out-of-pocket maximum or limit is the most an enrollee has to pay during their policy period (generally one year) before their plan begins to pay for 100% of covered health benefits. It is important to remember that annual out-of-pocket maximums do not apply for services obtained outside of one's network. For 2014 the maximum out-of-pocket cost limit for the Individual Marketplace is $6,350 for an individual plan and $12,700 for a family plan.
How can I find affordable health insurance?
HealthPocket offers a variety of tools that will assist you in finding health insurance that is affordable. Our plan comparison tool allows you to sort plans by monthly cost, deductible, or out-of-pocket maximum.
With the implementation of the Affordable Care Act, it is possible for low-to-moderate income individuals and families to qualify for health insurance premium subsidies for plans purchased on either the Federal exchange or State exchanges. Subsidies come in the form of tax credits and advance credit payments can be used immediately to lower your premiums. These premium subsidies do not apply to out-of-pocket costs such as copayments or coinsurance. Our plan comparison tool allows you to estimate your maximum monthly premium subsidy given your family size and income.
There are also special cost-sharing reduction plans also abbreviated as CSR that are in the Silver metal tier and are open to people with incomes up to 250% of the federal poverty level. People under the age of 30 also qualify for a catastrophic plan which has lower premiums than the metal plans, but does not qualify for subsidies.
Affordable health insurance through your employer
The Affordable Care Act included a mandate for employers with fifty or more full-time employee equivalents (a measure of total employees which includes hours from part-time employees) to provide affordable health coverage with actuarial value at least 60% for their full-time employees. In particular the mandate requires the employers to pay a penalty if any of their employees have to pay more than 9.5% of their household income for the employer coverage or if the employer coverage pays less than 60% of covered health care costs for a typical enrollee.
The employer mandate was supposed to take effect in 2014, but it was delayed until 2015 for employers with at least one hundred full-time employee equivalents. Employers with 50-99 full-time employee equivalents will have until 2016 to adhere to the employer mandate.