Under Obamacare, Will You Receive a Subsidy to Help You Buy Your Own Insurance? We Now Have Real Numbers That Will Let You Calculate How Much You Will Receive


Note to Readers: A longer version of this post appeared yesterday on HealthInsurance.org.

Up until now, when Obamacare’s supporters and reform’s opponents squabbled over what insurance will cost in 2014, they had to rely on estimates and national averages. But now we have real numbers.

Eleven states have announced the rates that insurers will be charging in their Exchanges-marketplaces where individuals who don’t have employer-sponsored coverage can shop for their own insurance.

Subsidies Will Be Based On the Cost Of A Silver Plan Where You Live,

Middle-income as well as low-income people buying coverage in the Exchanges will be eligible for government subsidies that will come in the form of tax credits. Anyone earning between 100 and 400 percent of the federal poverty level (FPL) (now $11,490 to $45,960 for a single person, and up to $126, 360 for a family of six) will qualify.

Most people who are forced to buy their own insurance earn less than 400% of FPL. More affluent Americans usually work  for companies that offer comprehensive coverage.

The graph below shows average Silver plan rates in the eleven states that have disclosed premiums. (Note that these are only state averages. Premiums vary widely within a state: In some cities and counties silver plan rates will be much lower, even before you apply the subsidy.

Silver plan premiums

It’s worth noting that in these 11 states the least expensive Silver Plan costs 18% less than the non-partisan Congressional Budget Office projected last year. 

Ignore headlines telling you that Obamacare has hiked premiums.  Fear-mongers are comparing rates for comprehensive coverage that will be sold in the Exchanges where insurers will be regulated to the rates insurers now charge for skimpy “junk insurancethat is barely worth the paper it is written on. These “Swiss Cheese policies” are filled with holes that you don’t discover until you become sick and fall through one of them.  

Now that we have solid information about Silver plan premiums, anyone living in California, Colorado District of Columbia,New Mexico New York Ohio Oregon Rhode Island  Vermont , Virginia or  Washington can calculate his subsidy by using the price of the benchmark silver plan as his reference point.

Even if you don’t live in one of these states, the announced rates and the examples below will give you an idea of the range of prices and the size of the subsidies Washington will be handing out.

                                         What Exactly Is A “Silver Plan”?

In the Exchanges, insurers will be selling Bronze, Silver, Gold and Platinum plans. All must cover the ten benefits that Congress decided are “essential” (outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, behavioral health treatment, prescription drugs, rehabilitative services, laboratory services, preventative care and pediatric services, including oral and vision care for children.)

All plans also must offer free preventive care, and they cannot refuse to cover you or charge you more because you suffer from a pre-existing condition.

The only major difference between the four tiers is that Platinum and Gold plans will require less cost-sharing in the form of co-pays and deductibles, though their premiums will be higher. Bronze and Silver plans, on the other hand, will boast lower premiums, with higher co-pays and deductibles—up to a maximum of $6340.  After that, the insurer pays the bills..

$6340 may sound steep, but if you earn less than 400% of FPL  ($44,500 for an individual )you won’t be expected to spend as much out-of-pocket:

Individual Income As Percentage of Federal Poverty Line (FPL) Your out-of-pocket liability will be reduced by
100-200%  ($11,490 -$22,980) Two-thirds
200-300% ($22,980- $34,470 One-half
300-400% ($34,470-  $45,960) One-third

                            Who Is Eligible For a Subsidy?

If your employer offers “affordable comprehensive” insurance you will not be able to buy coverage in the Exchanges. You already are receiving a subsidy from your boss. The Exchanges will be open only to the self-employed, the unemployed, and employees who work for a company that does not offer affordable health benefits. 

                       How To Calculate the Size Of Your Subsidy In Four Easy Steps

The size of your subsidy will be based on your income, the number of people in your household, and the price of the benchmark Silver plan in the town or county where you live.

1) Use the table below to find out whether your income and household size make you eligible. For instance, as the table indicates, a family of three with joint income up to $78,120 and a family of five reporting income of up to $110,280 can expect to receive a tax credit.

Percent of Federal Poverty Level (FPL)
Household Size 100% 133% 150% 200% 300% 400%
1 $11,490 $15,282 $17,235 $22,980 $34,470 $45,960
2 $15,510 $20,628 $23,265 $31,020 $46,530 $62,040
3 $19,530 $25,975 $29,295 $39,060 $58,590 $78,120
4 $23,550 $31,322 $35,325 $47,100 $70,650 $94,200
5 $27,570 $36,668 $41,355 $55,140 $82,710 $110,280
6 $31,590 $42,015 $47,385 $63,180 $94,770 $126,360
For each additional person, add $4,020 $5,347 $6,030 $8,040 $12,060 $16,080


2) Find out how much the Affordable Care Act expects you to contribute to the cost of your insurance by consulting Table 2 below . (If you decide not to buy insurance, you won’t have to make a contribution, but you will have to pay a penalty that begins at $95 in 2014.)

TABLE 2: If You Earn                          Your Expected Contribution Is

Up to 133% of FPL 2% of your income
133%-150% of FPL 3%-4% of your income
150%-200% of FPL 4%-6.3% of your income
200%-250% of FPL 6.3%-8.05% of your income
250%-300% of FPL 8.05%-9.5% of your income
300%-400% of FPL 9.5% of your income

The subsidy will make up the difference between the amount an individual is expected to contribute (based on income) and the actual cost of that silver plan in the city where you live.

3)  Contact your state exchange to find out how much a benchmark Silver plan will cost in the area where you live. (Some of that information is already available online. See the links to individual states at the end of the longer version of this post on HealthInsurance.org

4)  Subtract the amount that you are expected to contribute (see Table 2) from the cost of your benchmark silver plan. For instance, let’s say your silver plan costs $3000 a year, and you are expected to contribute $1000. You will receive a subsidy of $2,000

For specific examples of costs and subsidies, based on hard data from states that have announced premiums for individual towns and counties, see the longer version of this post on HealthInsurance org.   Please come back here to comment.


192 thoughts on “Under Obamacare, Will You Receive a Subsidy to Help You Buy Your Own Insurance? We Now Have Real Numbers That Will Let You Calculate How Much You Will Receive

  1. I used the calculator on my state’s (Washington) healthfinder website. For two adults (53) and one dependent (22) our monthly premium for the silver plan was over $1,400! We now pay $563. We don’t qualify for a subsidy (barely), and that premium is 22% of our income. Are those the real numbers? How is that affordable?

    • Frugal Nurse-

      Thanks for commenting.

      If a $1,400 premium represents 22% of your income, then you earn less than $7,000 (joint) and definitely qualify for a subsidy. $1,400x 5 = $7,000. Actually, you would qualify for Medicaid.

      Your numbers just don’t make sense.

      I truly hope you are not someone trying to use HealthBeat to spread mininformation.
      I hope you will reassure me by writing back and giving me hard numbers regarding your income. Then I can tell you whether you
      qualify for a subsidy and how much it will be. (It would also help if you gave me your location.)

      As the SEattle Times explains in the state of Washington: “Individuals making up to $45,960 and families of four making up to $94,200 a year will be eligible for subsidies if they buy their plans through the new online marketplace exchange created by the federal law.”
      The newspaper also explains that in Washington, premiums are lower than expected. http://seattletimes.com/html/localnews/2021013487_insuranceratesxml.html

      I tried using your state’s calculator, but it didn’t work. (It said that a family of your size earning $20,000 would be on Medicaid.
      This may be why you are confused.

      In addition, you don’t have to buy a silver plan. You can buy a bronze plan–which is less expensive–and apply your subsidy toward that plan.

      A Bronze plan would give you much better coverage than what you are now getting for $563. A Bronze plan would give you free preventive care, all essential benefits would be covered, and in anyone in your family becomes very sick or is in an accident, out of pocket spending would be capped.

      • I’m definitely NOT trying to spread misinformation, just trying to understand the numbers. If my monthly premium were $1400, that would be $16,800/year. If my income (gross) is $80,000, isn’t that roughly 20% of my income? Or am I not understanding?

      • You know this insurance thing is crap because here is the thing that medical people just do not get…. We need medical insurance where it’s not $1,000 per month but at the same time the co-pay is not outrageous…. If a person like me who has cancer needs to pay for not only the damn premium but also the co-pay… Oh by the way… Unemployed as well due to the illness…

        • Shawn if you’re unemployed, you should be eligible for Medicaid. (Unless you live in one of those states that have refused to expand Medicaid and won’t cover low-income adults unless they have children.

          If so that is your state’s fault–not Obamacare’s fault. The Affordable Care ACt called for expanding Medicaid in all states.
          Then the Supreme Court struck down that part of the law.

          Finally, I’ve looked at plans in many state Exchanges. Premiums are NOT $1000 a month for an individual And co-pays and deductibles are not outrageous.

          Zero–Deductible plans are available. Often co-pays are moderate.

          Don’t believe what you read in the papers. Go to your state’s Exchange and check things out.

          Or Call the Exchange and ask for a navigator to help you.

          “Zero-deductible” plans are available.

          • Maybe the person doesn’t want to receive medicaid and have their home be subject to asset recovery.

          • Kay–

            Under Medicaid, your home is subject to asset recovery only after you and your spouse have died.

          • Maggie Mahar needs to do some research. When Maggie said “you should” be able to receive Medicaid, she didn’t say you could. It actually takes 2 years from the time of declared disability to be eligible for Medicaid. In Shawn’s case, he’s a cancer patient and will face even greater costs because of this loophole. Obamacare is definitely not a friend of cancer patients.

          • DavidDurant “the man” —

            I suggest that you read what the American Cancer Society says about Obamacare. They see it as a huge plus for
            cancer patients. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-026864.pdf

            You are wrong about waiting times. The waiting time is two years for MEDICARE, not MEDICAID. And during those two years
            the person receives SSI benefits.

            In addition two year waiting time for MEDICARE has nothing to do with Obamacare, it was part of the legislation when disability benefits passed.

      • Have a question… would I get help with insurance. Kentucky is my state, legally blind drawing social security. Social security with child dependent totals about 23,000 a year. Does child support include in the income as well? I was curious I was denied help because a comment about not fiking taxes on social security. Then also denied because I said if I did file I wouldnt claim my child. I dont understand this, can u help.

        • kim-

          No, child support (from the child’s father) should not be not included when considering whether you are eligible for a subsidy. (Alimony would be considered as part of your household income, but not child support.)

          Have you looked into whether you qualify for Medicaid?

          But here’s one thing I don’t understand: why wouldn’t you include your child when applying for insurance in your state’s Exchange:

          Let me suggest that you call your Exchange again– you will get a different person, and my guess is that he or she will be
          more helpful.

          If that doesn’t work, feel free to comment here again, and give me more information:

          Are you talking about child support from the child’s father or child support from Social Security?

          What is your Total income (including all social security payments for yourself and your child) ?

          . .

          • One would not seek to include the child for support if the noncustodial parent is already paying 100% of the healthcare needs of the Child. If a person works 40 hours a week at $10.00 per week and receives child support, if the child support were counted he or she would qualify for a subsidy. Otherwise in many cases against their will they are forced to check out Medicaid. This loophole should be addressed.

          • Rick– You’re entirely right– if the noncustodial parent is paying 100% of healthcare, the custodial parent cannot include the child in
            application for a subsidy

            I’m not sure I understand the second part of your comment– There may be a typo. Do you mean, If the child support were counted he or she would
            NOT qualify for a subsidy?

            That is true, and SCHIP or Medicaid might well be the best alternative. But I don’t quite see how this is a loophole.

    • There is something wrong with this Obama care for sure! I was totally for it until I called and gathered information from a representative. If employer based insurance is offered, but you passed on it before the marketplace opens you do not qualify for any help with premiums. This makes the costs very high for me. Yet, I am unavailable to get insurance through my husbands employer until 6 months from now. Also, the afforadable factor for the two of us is based of my husbands insurance premium only- not what it costs for the both of us. The employer has to stay under 9.5% of wages. This is not the case for both our premiums though- however it doesn’t matter. Health insurance isn’t affordable at his work a it is $625 a month. This marketplace is a joke. I am let down . This is all information from the source too.

      • Bri-Alex–

        I don’t know where you got your information.

        If you refused employer-sponsored insurance this year that has no affect on whether you qualify for help with premiums in 2014.

        If your employer does not offer affordable, comprehensive coverage, you can purchase insurance in the state marketplaces where you will be eligible for help with premiums if you earn less than 400% of the FPL.

        Your husband’s employer is not responsible for insuring you. (He is required to insure your husband’s children, but not a spouse.) These days, women are not viewed as “dependents.”

        This has nothing to do with Obamacare. By law, employers were not required to insure spouses before Obamacare. In 2012 6% of employers did not insure spouses.

        If you don’t work, that is your choice–but that is not a reason that your husband’s employer should insure you. You can go to the Exchange to buy your own insurance.

        In the Exchange, you may or may not qualify for a subsidy–that depends on income.

        Finally whether $625 a month for insurance is affordable depends on earnings. IN Europe, most people spend close to 10% of income on health insurance (mainly through the extra taxes they pay for universal health care.) That means that someone who earns roughly $75,00 pays $625 a month.

        • At my husbands place of employment they offer insurance that covers family, there is no reduction of rates if the spouse doesn’t go on the family plan. Now we HAVE to take that plan for the kids, so it would be dumb to not add me to it as well and go out and spend more money we don’t have on a plan from the exchange.
          His plan comes in at just over 5% of his income for the year, it has a 5000.00/person deductible AND then only cover 80% of allowed procedures which we have found to be pretty much nothing! Now if we add the family plan that amount jumps to 17% of gross income, more than our house payment! How is that affordable? Why aren’t we eligible for the same rate reductions those not offered insurance through their employers? Going through the exchange it says that we would be liable for 1400 a year for a silver plan because that is what the government says we can afford(and that is with adding in my self employed income), but somehow since his employer offers insurance the government thinks we can afford 6 times that amount?
          I am mystified where I am supposed to come up with an extra 7000.00+ a year simply for the privileged, should something happen, to spend another 5000.00/person. That is more than a quarter of our income combined and hardly protects us from financial ruin.

          • Snowed–

            First, why wouldn’t you want to include your kids on your husband’s health care plan?

            I realize that this might cost more, but wouldn’t you want your kids to be protected? (Kids are not that
            expensive to insure. The extra that you would be charged would not be that much. I’d urge you to check it out.)

            Secondly you say that your husband’s plan covers 80% of costs.You say that is “NOTHING.” No, 80% is not nothing.
            It is 80% more than 0%

            Third: Why are you not eligible for the subsides that people who don’t have employer-sponsored benefits can get?
            Becaause you are already subsidized by your employer. That subsidy (which is larger than the subsidy you would get in the Exchhanges

            Finally, you are not expected to spend more than 9.5% percent of your income on health insurance. That is NOT 9.5% of your income” “after our house payment.”

            IF you have chosen to purchase a home that you cannot afford, that is your choice. It is not a problem that
            the government –or other taxpayers–should subsidize by helping you pay for your health insurance.

          • Maggie. YOU are mis informed.

            My family and I are offered health benefits through my job, but we can’t afford to enroll. My employer pays 100% of the premium for workers, but contributes nothing toward the cost of adding my wife and kids. Can we try to find a better deal in the Marketplace?
            You can always shop for coverage on the Marketplace, but your family members won’t be eligible for tax credits to help pay the premium. When people are eligible for employer-sponsored coverage, they can only qualify for Marketplace premium tax credits if the employer-sponsored coverage is unaffordable. The way this is calculated, coverage is unaffordable only if your cost for coverage for a single person under the employer plan is more than 9.5% of your income. So although you may feel your family coverage is unaffordable in practical terms, it is considered technically affordable.

            If your family members end up uninsured because family coverage is unaffordable, they will not have to pay a tax penalty under the “individual mandate.”

            ^^ paying 20 percent of gross income for family coverage through an employer is not affordable.. But are deciding what is affordable by placing it on the rate for the employee, not the family. If a family is offered coverage through the employer they are not eligible for subsidies regardless of if the employer coverage is affordable are not. Do some more research..

          • A.c.–

            I am well aware of the fact that people can qualify for subsidies in the Exchanges only if the employer-sponsored coverage costs for the employee costs more than 9.5% of the family’s household income. I have written about thiss.(I just can’t repeat every point in every post. )

            But when you say that under Obamacare, employers do not have to cover children, I am afraid that you are misinformed.
            In most cases, employers do have to cover dependent children, This does not mean that they have to cover 100% of the premium, but children are fairly cheap to insure, so the cost to you should not be very high.And under Obamacare, insures in all states have to offer “child-only” policies that don’t have to cover adults.

            (Btw you are very lucky to work for a boss who covers 100% of your premium. Very, very few people are that lucky)

            At the same time, you are right: under the Affordable Care Act, employers do not have to cover spouses.

            This is because that, today, so many women work, and reformers believe that their employers should provide health care. There is no reason that a woman’s employer should be able to shift costs to her husband’s employer.

            I agree that the problem in the law that that you describe needs to be fixed. When a spouse doesn’t have access to employer-based insurance, then he or she should have access to the husband’s (or wive’s) employer-based insurance. The goal of health care reform is to make sure that everyone has access to affordable care. Reformers are well aware of this problem. . But right now, they are trying to roll out Obamacare for the millions of people who will be helped.

            I am very, very sorry that right now, your and your family are falling through the cracks.

            But I believe that, before long, your wife will either be covered by her employer (assuming she is working) or your]
            employer will be required to offer insurance to spouses who who have no access to insurance.

            In the meantime, I would urge you to check out “child-only” insurance in your state’s Exchange. Your are right : your kids need coverage, and I think you will find that it is surprisingly affordable (especially because you pay nothing for your own healthcare)

          • To Maggie: who are you to say these people cannot afford their home and that is not your problem (or anyone else’s). They were fine before the ACA fiasco as were many people but the increased healthcare costs due to this increased subsidy of the uninsured (whom we already covered in one way or another before this unwarranted; misdirected, imposed re-distribution of income) has changed the financial picture of many family’s resulting in their previous budget (including house payments) becoming unsustainable. That is the responsibility of the government. It is not o.k. to change the rules mid stream and essentially take a large chunk out of a family’s budget at will.

          • Kay–

            You are right–the ACA does involve a redistribution of income. People earning over $200,000 are paying higher taxes so that people earning under $45,000 can have subsidies to help them buy insurance.
            In addition, the upper-middle class and upper class (family of 4 earning more than roughly $93,000) are being asked to buy
            comprehensive insurance–pooling their money with median-income and low-income folks– so that everyone can have
            comprehensive insurance. It’s a matter of thinking collectively–in terms of “We”–rather than thinking in terms of “me and my family.”

            I’m sorry you are not comfortable with this, but it’s necessary–and it’s the future. Politicians and policy-makers are becoming increasingly aware that income inequality is creating great problems for the economy–and for the society

        • I lived in Europe, Germany to be specific, for 4 years and understand their health care system quite well… That may be true they are paying that in taxes but I will tell you this… At least they know where that money goes because they don’t even need insurance due to the health care they can receive automatically… So that is not a valid point on anything… Not to mention it’s still doesn’t make it right that our system is crap because they expect to either make you pay high dollar monthly premiums or a crazy expensive co-pay.

          • My step son and wife also lived in Germany for a number of years and the health care there is very good.

            People do pay for it (through taxes that are much higher than taxes here) but as you say people know where money is going,
            and are happy with the system.

    • Frugal nurse: you get health care for 3 people for $563/month? That is incredible! What is the deductible on this plan and does it cover preventive care (annual physicals, cancer screenings, vision exams, etc)? I am a single person, younger than you, in excellent health w/no medical conditions, and I pay $173/month for a plan with a $7500 deductible.

    • This is all a bunch of rubbish! I was paying $170 a month for myself for a major medical which worked fine for me . (BCBS) they come back and the plan is now $360, maybe a bit better but not that much. My wife and I make around $50,000 between us and have no dependants though our adult son still lives with us-college student.The government plan gives us a whooping $24 credit and their plan is even more expensive that BCBS! Ridiculous to call this affordable! Maybe if I didn’t have other bills to pay, but heck, one needs more than just health coverage!

      • Greg–
        IN other counties that have universal healthcare, people pay an average of 10% of their income for it (usually in the form of taxes). $360 a month works out to significantly less than $5,000.

        Secondly, I’ve looked at enough policies in the individual market to know that a policy that cost $170 was riddled with holes and probably left you exposed to financial catastrophe.
        If it “worked fine for me” you were lucky–you didn’t have a terrible accident or weren’t diagnosed with a serious illness. But for all of us, it’s just a matter of time.
        Finally, health care reform is not about finding a solution that “works fine for you or me”–it’s about finding a solution that works for all of us- with all of us paying premiums to
        cover each other.
        It’s not likely that I will ever be diagnosed with cancer (no cancer in a very large extended family) but that doesn’t mean that my premiums shouldn’t reflect the cost of treating cancer. With health insurance, we’re all paying for some things that (with luck) we’ll never use.
        That’s what insurance is all about “pooling the risk.”

      • Trade places with me? I make $23k a month, and am currently uninsured. I’d LOVE to be able to have your $50k a month, so I could complain about having insurance at only $360 a month. That’s an insanely low rate.

        • Hannah–

          I’m assuming you mean you earn $23,000 a year. IF so, you qualify for a very good subsidy in the Exchange.
          Look at silver plans and see whether you also qualify for subsidies that will help cover the deductible and co-pays.

  2. The subsidy will be based on the cost of the 2nd least expensive silver plan available in each market. In addition, even if one chooses an even less expensive Bronze level plan, the individual’s required maximum contribution will still be a function of his income.

    The recent NY Times article that focused on young healthy people in Oregon suggested that many of these folks, especially young men, see even $100-$150 per month as too much money from their comparatively modest incomes to spend for something they don’t think they need and won’t use very much of in all likelihood. Also, the fact that the penalty is initially capped at 1% of income or $250 for someone earning $25K per year makes it an easier decision to pass on health insurance unless and until you get sick and buy it then even if you have to wait for the next open enrollment period. If all else fails, with few or no assets, high doctor and hospital bills can be eliminated or drastically reduced by declaring bankruptcy.

    I hope enough of these young healthy people sign up for insurance to keep premiums affordable for the older segment of the uninsured and underinsured population but there is a huge risk that too many of them will opt to pay the penalty. We will know soon enough.

    • Barry-

      We’re not talking about $125 a month.

      We’re talking about $500 a year–or less.

      In some cases when a young man applies his subsidy, his premium will be $0. That’s right zero.
      For that he gets free preventive care, and a cap on out of pocket spending. (IF he earns less than 400% of povery–and most young men who
      will be in the Exchanges do–he his out of pocket spending will also be subsidized. So even if he’s in a bad car accident, his total exposure would be limited to about $2,000. The deal is too good to turn down. )

      I’m writing about rates for 20-somethings and young 30-somethings now, using the info from the states to calculate subsidies–using real data.
      Relatively few people have figured out how to calcualte the subsidies and very, very few have written about how cheap a bronze plan will be when you apply the silver plan subsidy. Oppponents of Obamacare don’t want people to know.

      As for the $95 penalty– would you rather pay a $95 fine–and receive nothing in return– or receive a $4000 subsidy from the government.
      Our experience in Mass. showed that people don’t like to pay something for nothing. On the other hand, they very much like the idea of getting something free form the govenrment.

  3. Correction: The article that focused on young healthy people in Oregon was published in the July 25th issue of the Wall Street Journal, not the New York Times.

  4. Maggie –

    The issue that is unclear to me is the amount of the subsidy and the maximum percentage of income any given person will be required to spend for health insurance if he or she opts for something less than a silver plan – either a bronze plan or, if 30 and under, a bare bones catastrophic plan. I couldn’t find any clarification of this issue on the Kaiser Family Foundation subsidy calculator site.

    By the way, according to Kaiser, the definition of income that will be used to determine eligibility for subsidies is Modified Adjusted Gross Income (MAGI) which, I’m pretty sure is the same definition that the Social Security Administration uses in determining who is subject to the IRMAA surcharge on Part B premiums. MAGI is gross income from wages, interest, dividends, capital gains, social security benefits, etc. It does not include income from survivor benefits, gifts and inheritances.

    In reading the Wall Street Journal story yesterday about the young and healthy in Oregon, it seems clear to me that many of these people have a very different perception of value for money as it relates to health insurance than you do and it’s that perception that will drive their decision to purchase health insurance or pay the penalty. Health insurance appears much more valuable once we’ve gotten older and actually incurred some significant medical claims. When you’re young and healthy and feel invincible, a different attitude is likely.

    • Barry–

      You can’t apply a subsidy to a high-dedutible plan offered on the Exchanges for people under 30.

      But you can apply the subsidy to all Bronze, Silver, Gold and Platinum plans.

      Modfified Adjusted Gross INnome (MAGI) is often Lower (and never higher) than “gross income.”

      As I am sure you know, MAGI is income after deducting contributions to retirement plans–and if you’re self-employed,
      MAGI is after deducting costs of health insurance.

      Thus,that many more people will qualify for subsidies.

  5. One more interesting wrinkle on the subsidy issue is that the definition of poverty level income is the same nationwide. At the same time, salaries in high cost cities tend to be higher than in lower cost areas for similar work. Health insurance premiums will also be higher in the high cost regions because medical input costs like salaries, benefits and office rents are higher. So, people who live and work in high cost areas will qualify for lower subsidies to offset higher premiums than people doing similar jobs in lower cost regions.

  6. Frugal Nurse –

    If your family income is $80,000 and you’re a family of three, you don’t qualify for a subsidy because the subsidy limit of 400% of poverty for a family of three is $78,120. You’re a victim of what I call the cliff phaseout. This means that with income of 400% of poverty, you would have qualified for a subsidy of $9,378.60 while your out-of-pocket contribution toward the insurance premium would be $7,421.40 or 9.5% of gross income. However, if your family’s gross income is 401% of poverty or higher you’re not entitled to a subsidy. Yours is 409.6% of poverty.

    I’ve written about the cliff phaseout before and even Maggie thinks it’s unfair. A gradual phaseout that provides for the loss of $1 of subsidy for each $3 of income above a maximum threshold would have been fairer. Under that approach you would have still been entitled to a subsidy of $6,795 and you would have paid $10,005 or 12.5% of income out of pocket for the premium. On the other hand, for budget reasons, I suspect that if legislators opted for a gradual phaseout, the income threshold at which the phaseout started to take effect probably would have been closer to 300% of poverty or 350% at most.

    • Thanks for the reply, Barry. That does seem remarkably unfair (not to mention unaffordable). The actual premiums for the Washington exchange plans are still awaiting approval from the Insurance Commissioner’s office. I just hope they prove to be lower than what the state’s premium calculator is telling me. Otherwise…?

      • Hi, Frugal Nurse–

        I’m very sorry- I was reading quickly and missed the fact that your Monthly premium would be $1400.

        Below, a much better response to your comment. I hope you’ll write back.

        Part of the problem is, as Barry suggests, that you earn just a little over 400% of the Federal Poverty Line–that’s the cut-off for subsidies.

        Though in truth a family of 3 with income of $80,000 earns more than 50% of all 3-person households in the u>S. (In other words, you’re
        just a hair north of “median income”. 50% of all families of 3 in this country earn more than you; 50% earn less.

        This is why Congress drew the line where it did. (Barry implies the line is arbitrary–that isn’t quite true. Maybe there should be a phase out, but that would have made it that much harder to get any bill passed.)

        The truth is that your real problem is your age–and the fact young Americans just are not willing to help support healthcare for older Americans (even though when they are older, they will, no doubt, expect Social Security, Medicare, etc.)

        As a result, Congress knew that when it passed Obamacare, it would have to let insurers charge someone your age up to 3 times as much as
        it charges a 25-year-old. This is why your premiums are so high

        Barry is a libertarian, and libertarians think this is okay. (Each individual should pay for himself) I don’t agree

        In Europe ,and in virtually every other developed nation, younger citizens help pay for heatlhcare for older citizens. They understand that the whole point of insurance is to “pool” the risk and the costs. People who are lucky enough to be healthy and young help pay for those who are sick or older. None of us know when we will need expensive health-care–a 25-year old can be diagnosed with brain cancer or hit by a drunk driver. And eventually, all of us will be old. This is why generations need to help each other.

        But in this country, 20-somethings and 30-somethings resent and even dislike older Americans.(One day I was walking down the street in my supposedly civilized, liberal Upper-West Side Manhattan neighborhood and overheard a young couple walking behind a frail 70-something man who was walking slowly: The couple shouted out: “Get going, Old Man!.” This wouldn’t happen in Italy, France, Japan or vitually any Western European nation.

        Like you, I am a 1st-generation (middle-aged) baby-boomer. When I travel to Europe I am treated very differently than I am here. Young people offer me a seat on a crowded subway, and in general, are both warm and polite. Most like and respect their parents and older relatives. That translates into being civil and kind to older strangers. There is a respesct for age built into the civilization.

        One of my readers once commented: “I’m willing to help my mother, but not someone else’s mother.”
        As a result, Congress didn’t dare pass legislation that would provide healthcare for all at the same price. They knew that younger Americans who belong to the “ME Generation” would vote them out of office. (Though a couple of states, including New York, still won’t let insurers charge older Americans more than they would charge a 25-year-old. .)

        IF you were 20-something , you could get a silver plan in King County Washingoon (I think ths is Seattle) for 166-$279 a month.

        Your 26-year=old dependent could also buy a Bronze plan for much less. Or buy a high-deductible catastrophic plan (available to anyone under 29 ) for even less.

        Then you and your husband could buy a Bronze plan. Premiums would be significantly lower than for a Silver Plan and you would get the same benefits– coverage for all 10 “Essential Benefits”, free preventive care, and a cap on out-of pocket spending.

        If you landed in a hospital or were disagnosed with cancer, you wouldn’t have to declare bankruptcy or sell your house.

        This is very, very different from the cut-rate insurance you have today. That insurance offers you very little protection.

        I agree with you that when your state approves rates, they may well come down.

        I hope so.

        I hope you’ll get back to us.

        • Maggie and Barry, thank you both for your replies. I appreciate your comments.

          Maggie, I do not consider my current insurance cut rate at all. It is a catastrophic plan, yes, but with an HSA. Over the last few years our deductible has come down to $7500 for the family, and $10,500 out of pocket max (including the deductible). As we are all healthy, that works fine for us. Also, our preventive care is, as you say, free (although since our premiums have risen considerably, I prefer to call it pre-paid). Worst case, we could use the money in our HSA to cover our OOP costs.

          I would like the option to keep our current plan, as that works well for our family, but I’m not sure that will be an option. We can certainly still purchase insurance outside of the exchange, as we won’t get a subsidy anyway, but I don’t know yet what those premiums might be.

          By the way, my son is still a full-time student. When all the insurance plans are finally made available, I will certainly crunch the numbers every possible way.

          My big problem with Obamacare is that it has not addressed what I consider to be the root problems of high health care costs. I am a nurse and have been in health care for 30 years. Some health insurance reform was necessary, for sure, but unless other cost-related problems are addressed (tort reform, pharmaceutical caps, price transparency and regulation, for a start), our system will continue to be unsustainable.

          I read “The Healing of America” by T.R. Reid and agree that America could have done better by following some examples in Europe and Asia, such as Germany, France, Taiwan and Switzerland.

          That said, I am still concerned with finding affordable insurance for my family. It seems to me that while Obamacare makes insurance more affordable for one set of people, it makes it less affordable for another. Perhaps I’m in the minority, but if so, that really sucks for me.

          • Frugal nurse-

            Certainly for upper-middle class people who earn just a little too much to qualify for a subsidy, Obamacare may be financially disappointing. They won’t save money and may pay a little more than they do now (though no one will be asked to pay more than 9.5% of income, which is about what people in Europe pay for healthcare, usually through taxes.)

            And , as you say, a great many more middle-class and low-income people will be helped.

            As a nurse, I’m sure you care for those people. So rather than focusing on “Will this Suck for me” (and I don’t think it will) you
            might want to think about how much better it will be to live in and workin a s ystem where, more and more, health care providers will be paid to collaborate and co-ordinate care (nurses and doctors working together). If they don’t there will be financial penalsites. IF they do, and they achieve better outcomes for less (we know they can –we have many examples in this country) they will receive financial rewards.

            You are now working in a chaotic fee-for-service system which rewards hospitals and doctors for “doing more”–whether or not it helps the patient.

            Over time, under reform, this will change. (It won’t happen all at once, but we’re moving in the right directoin.)

            I agree about Reid’s book. He shows what is wrong with our money-driven system. But the Affordable Care ACt (which I have now read several times) is based on the lessons to be learned from Europe.

            What is different about Europe is that people tend to think collectively –in terms of “we” not in terms of “me and my family.” We Americans are so divided– by class, by race, by gender . . . A friend who lived in France for many years says that healthcare is so good in France because “the French think that nothing is too good for another Frenchmen” (and this includes immigrants who have come to France.

            If we learned to feel that way about each other, this country could be much more successful in so many ways.

    • Barry–

      If you wanted to help “Frugal Nurse” I wonder why you didn’t advise her that if her adult child
      appplied for health on his or her own, he or she could probably qualify for a fat subsidy?

      (I’m assuming their 20-somethign child works–even if part-time, or in a low-age job
      If not, he or she could be on Medicaid and get healthcare for free)

      Meanwhile, you might have mentioned that the parents could apply for a Bronze plan –which would include l all of the benefits of a
      Silver plan, with much lower premium.

      At their ages, with just $80,000 joint income, they definitely need something much, much better than the very low-cost junk insurance that they have now.

      When readers reply to each other, I hope that they will try to help each other.

  7. Maggie –

    For the record, I don’t consider myself to be a libertarian. I’m a centrist / moderate Republican. I believe in market solutions to economic problems where possible and only look to a government solution after the market has clearly failed after getting a fair chance to work. I’m liberal on all the social issues. Interestingly, my wife’s views are similar to mine but she’s a Democrat because she puts a lot more weight on the social issues than I do. The economic issues are much more important to me.

    With respect to Frugal Nurse’s current insurance policy, I would like to know more. How much is the deductible? Are there significant limits on hospital based care? Is there an annual or lifetime benefit cap and, if so, what is it? Is it a narrow network or HMO plan? It’s conceivable that it’s considerably better than you think it is but we would need more information to make that determination.

    Regarding young people and their unwillingness to subsidize older people to the extent that you think they should, I think it’s due to a cultural difference between our country and most of the Western European countries and Canada. They embrace the concept of community and solidarity and are willing to pay very high taxes to sustain a comprehensive social safety net including health insurance for all. The U.S. culture leans more toward freedom, liberty and individual responsibility and choice. I don’t think that’s likely to change anytime soon.

    By the way, if we financed healthcare the same way as Germany does, primarily with a payroll tax up to a middle income wage cap of €45,000, the combined employer + employee share would be north of 15% of income on top of the 15.3% of income that they already pay for social security and Medicare. That’s asking a heck of a lot from a young low wage person for benefits he either won’t collect for decades and/or is unlikely to need very much of in the near term.

    The Swiss insurers must charge the same premium for everyone 26 years old and older and only slightly less for those 18 to 25. There is no such thing as the equivalent of Medicare or Medicaid in Switzerland but 45% of the population qualifies for a subsidy. It may work for them but I don’t think it would work for us especially since our healthcare costs are considerably higher.

    • bBarry-


      I assumed your were a libertarian because so often what you say matches up with the Cato Institute’s party line.

      You write: “The U.S. culture leans more toward freedom, liberty and individual responsibility and choice. I don’t think that’s likely to change anytime soon.”

      Another way to put that is that the U.S. culture leans more toward individualism and independence (“every man for himself” )
      If you want to talk about freedom and liberty, you have to look to the slogan of the French Revolution: “LIberty, Fraternity, EQuality,”
      Brotherhood and Equality were never part of our philosphy. From the beginning, this country was built on the backs of slaves,
      and sharply divided between an elite white male property-owners (the only people able to vote ) and the rest.

      John Adams was one of the very, very few among our founders who have any understanding of “fraternity” or “equality.”

      As for whether this country will change, I remain hoepful that, yes it will. Inter-marriage will reduce teh racism. And as both
      minorities and women like your wife shape our values, we will put children, equality, and tolerance ahead of $$$. (Good for her!)

    • That is one of my points…. Why is American health care so much higher than anywhere else??? That is what needs to be fixed… Only then will everything else seem to balance out…

      • Shawn:

        Our health care is far more expensive for two reasons:

        No. 1: Americans who are insured are over-treated. They undergo far more surgeries than the citizens of any other developed country.
        We know that many of these surgeries are unneecessary: about half of heart surgeries temporarily relieve angina, but do nothing to reduce mortalities. In the U.S. many more women have C-sections–not because they want them but because doctors insist. (In Europe nurse midwives are more likely to deliver babies and they are trained to be patient and let labor proceed naturally–unless, of course the child or mother is in danger. )

        Why so many surgeries? Our doctors are trained to be pro-active. And U.S. patients have come to expect aggressive medicine: Do Something Now! Finally, our hospitals and doctors profit from these surgeries.

        (U.S. doctors are paid far more than doctors in Germany—even after factoring in the lower cost of living in the U.S. and the fact that in the U.S. med students graduate with debt.)

        Many U.S. hospitals look like resorts– marble lobbies, expensive art, mahogany paneled conference rooms for docs, mostly private rooms–some with jacuzzis for patients, — etc. etc. Who pays for this? Patients in the form of higher bills.

        (As you probably noticed, in Germany hospitals tend to be fairly Spartan.

        In addition well-insured Americans undergo many more tests that people in other nations.
        And we’re over-medicated. (Again this is part of our medical culture: doctors are taught to diagnose by running tests (rather than listening to and talking to the patients) and they are taught to prescribe. Pharmaceutical companies encourage them to prescribe the most expensive drugs. This is what many Americans want–or at least have come to expect. )

        No.2– In the U.S. prices are unregulated. We are the only country in the world that has chosen to turn healthcare into a
        largely unregulated for-profit enterprise.

        In all other developed countries the government regulates how much doctors and hospitals can charge– and how much drug-makers and device-makers can charge. The government does this in various ways: in some countries, the govt sits down and negotiates doctors’ fees with doctors every year. However they do it, the government push back against rising prices. Politicians know that if they agreed to price increases, taxes will have to go up. And this will not be popular.

        In the U.S. no one is pushing back. By and large everyone in the U.S. health care industry charges as much as they can.
        And since 70% of our health care dollars are spent when we are very sick, in many cases they can charge whatever they like.
        Sick people don’t negotiate.

        They need a government that will stand up for them.

        Under the ACA, we’re beginning to push back. Medicare is refusing to pay for certain pointless care, and it’s trimming payments to hospitals. In the near future, I suspect that Medicare will begin negotiating with drug-makers and device-makers, saying
        “No, we won’t pay twice as much for your new product. You have no evidence that it’s twice as good.”

  8. Frugal Nurse –

    Thanks very much for your response. As I suspected, your current insurance policy is not full of holes but comprehensive with a high deductible coupled with an HSA. Did you buy it in the individual insurance market or is your employer also contributing significantly toward the premium?

    I agree with you 100% about the need to attack the underlying cost of healthcare in this country. Tort reform, including safe harbor protection for doctors who follow evidence based guidelines and protocols where they exist, would be enormously helpful in my opinion. However, trial lawyers are a key constituency for Democrats so this good idea has a steep hill to climb.

    For pharmaceuticals, we should use reference pricing like Germany and a number of other countries do. This means we would pay for the most cost-effective drug in a therapeutic class and if a patient wants a more expensive drug, the patient would pay the difference though the higher cost drug could be paid for on a pre-authorization basis if the less expensive drug didn’t work or the patient can’t tolerate its side effects or the doctor can justify it on some other basis.

    Robust price and quality transparency tools are something I’ve been pushing for since I started participating in healthcare blogs in 2006. If it were easier for patients and referring doctors to identify the most cost-effective high quality providers in real time, we could direct more of our healthcare business to them and create countervailing power against famous hospitals and those with significant local or regional market power. These hospitals command higher prices because of their market power and not the quality of their care.

    There also needs to be special rules governing how much hospitals can charge for care that must be delivered under emergency conditions which, by definition, cannot be scheduled in advance. I would limit prices for this care to 115% of Medicare or so even if an out-of-network insurer as opposed to an individual patient is paying.

    Finally, there is a lot more we can do to fight fraud in Medicare and Medicaid. Medicare has a huge claims database and it needs to be made available, including payment down to the individual physician level, to outside analytics firms that can help CMS ferret out fraud.

    While there is excess utilization of healthcare in the U.S. in certain areas of medicine and more in some geographic areas than others, the bigger problem is the high prices per service, test, procedure and brand name drug that prevail in the U.S. As Uwe Reinhardt and several others wrote in a famous 2003 article published in Health Affairs magazine, “It’s The Prices, Stupid.”

    • Barruy —
      As most people who have studied the high cost of care in the U.S. will tell you,
      the problem is a combination of overtreatment and high prices.

      The number of surgeries performed in the U.S. far exceeds surgeries in any other country in the world. (See Atul Gawande)
      We are over-medicated.
      We are over-tested. (See Gilbert Welch on the “epidemic of testing”)
      We have way to many MRI machines, etc.
      Way too many C-sections are done. (And more children and mothers die during labor)
      Way too many Americans who are clearly suffering from a terminal illness die in ICUs.
      Our fear of death, Greed, and our insitence that anything can be (and should be) cured drive overtreatment.

      That said, of course we pay too much for everything. But that simply hurts the economy.
      By submitting to over-treatment we hurt ourselves and our lovedd ones.

  9. Countries like Canada and Germany do not hire NFL stars to persuade young people to support older people through buying health insurance.

    They just tax the young people.

    Public schools are no different. We do not politely ask older people with no children at home to sign up for adult education, just in order to pay for elementary schools.

    We just tax the older people, usually property taxes.

    We could have paid for the ACA by raising Medicare taxes or Social Security taxes or income taxes, or a little bit from all three.

    Dr Robert Evans has some great pieces on the simplicity and fairness of using taxes to pay for health care. I still read them though they are kind of hard to find on the Net.

  10. Bob –

    Whether you like it or not, we can’t raise taxes in this country by executive order. We can only raise them if a majority of both houses of Congress pass legislation that does that and the president signs it. In the Senate, it effectively takes 60 votes to clear the procedural hurdles before the final legislation gets to the Senate floor and a final vote.

    To help pay for the ACA, we did raise the Medicare tax by 0.9 percentage point on incomes above $200K for single people and $250K for couples and we also applied it to investment income (interest, dividends, and capital gains) above those thresholds.

    It’s worth noting that in Germany, in addition to health insurance, pensions, unemployment insurance and long term care are also financed via payroll taxes. For all four of those combined, the employer + employee share adds up to 40% of payroll up to the maximum wage to which those taxes apply. How much support do you think there would be in the U.S. for a 15%-20% payroll tax on top of all the other taxes we pay to replace privately funded health insurance for the under 65 population plus cover the currently uninsured? Good luck getting that through Congress. It won’t happen.

    • Barry–

      I think you ignore both how much support Republicans have lost in the past 8 years and the changing demographics in this country.
      Over the next 4-6 years, I predict that Democrats will take the House and the Senate will be much more liberal. Some very strong progessives are joining the Senate (Corey Booker, Elizabeth Warren.
      They will be the Senate leaders of the future.)

      If Hillary Clinton takes the White House–which current polls say she will (assuming she runs)–and Nancy Pelosi remains in the House (which she will) we will have a progressive, smart government.
      These are people who know how to get things done. John Kerry will be part of the mix, and that will be helpful.

      Will the many new Latino, African-American, voters vote for people who say they will raise corporate taxes, raise the inheritance tax, and raise income taxes for people earning over $150,000–to $200,000? You can bet they will.

      And they will be joined by progressive women (of all colors) who care far more about their families than about pouring money into the “industrial military complex” that Dwight Eisenhower warned us about. Today, midlde-aged women are far less likely to vote with their more conservative husbands. They think for themselves.
      The older white men who have been running Congress since the 80s are dying out. It’s not just that they are aging; they are losing power. People don’t like Mitch McConnell. They can see the anger in his face–anger because he knows he is losing power, and is on his way out. This is what makes him mean. (By contrast, the American people like Bill Cliton. And Bill Clinton is not mean.

      As you know, tax rates for the top 5% are still historically very, very low. Most people in the lower 50% understand that. Unlike some low-income white males, Hispanics, African Americans and women have few illusions that someday that too will be millionaires . They understand that lower inheritance taxes will never help them. We all are hurt when too much money is consolidated in the hands of too few families. They also understand that when corporations pay less in taxes, investors may prosper, but that wealth does not “trickle down.” Precious few people in the lower 50% own stock. .

      And as we move toward a system that provides safety nets like healthcare for all, pre-K for all (which is coming) better daycare for all
      (which is coming) paid maternity leave, at least for government workers (which is coming) and better public schools with small classes (which is coming) as well as repariing the infrastructure that has been neglected for decades, the wealthy will pay taxes that are close to the taxes paid in Western Europe.

  11. Barry, I once read a blog post by a Canadian who said the following as I remember it:

    “It is absolutely true that I pay at least 10% higher taxes than does an American……

    but after I have paid my taxes, then 100% of my health care is taken care of with no out of pocket cost.

    At the end of the day, I have more disposable income than an American with my same wage. If I make $50,000 and pay
    $15,000 in taxes, then the $35,000 that remains is all mine.
    The American may think he is better off because he keeps $40,000…….but by the time he buys his own insurance and pays out of pocket in many ways, he is worse off than I am.”


    Let me add a completely unscientific observation. I have visited many national parks. Sometimes I saw as many Canadians in the parks as Americans.
    Maybe they did have more disposable income!
    Also, Canada has much stronger unions than us, so these workers had much longer paid vacations than most Americans.

  12. Bob —

    I think the typical middle class American pays 30%-33% of his income in combined federal, state and local taxes and probably a bit more in high tax states like NJ, NY, CA and IL. If you count the employer share of the payroll tax which most economists say we should and also count it as income to the employee, then the social security and Medicare tax alone consume 14.2% of income for middle class people (15.3 / 107.65). The average NJ family pays 11% of income in local property taxes while even someone who rents and spends 25%-30% of income for rent is paying 5%-6% of income in property taxes which are embedded in the rent. Throw in modest federal income taxes plus state income taxes, sales taxes, gasoline taxes, utility taxes, etc. and it’s easy to get above 30% of income. That doesn’t even count corporate income and property taxes which I believe are built into the price of the goods and services we all buy. The Canadian counterpart is probably paying closer to 40% of income or a bit more to the national and provincial government including sales and personal property taxes but not corporate income and property taxes.

    In Canada, everyone is covered by health insurance and no money changes hands at the point of service. That’s great but they have lengthy wait times for numerous procedures that are not immediately life threatening. These include hip and knee replacements, back surgery, imaging, colonoscopies and many others. Wealthier Canadians who don’t want to wait often come to the U.S. to get care faster. There’s the old saying that we can have our healthcare good, fast or cheap. Pick any two.

  13. Bob–
    When it comes to raising taxes, we cannot raise taxes on the middle class.
    When you look at their after-tax wages (adjusted for inflation), you will see that over the past three decades that thave fallen. They are losing ground–which is another way of saying that our middle class is disappearing. Middle class families cannot afford to send their kids to college.

    We also cannot raise payroll taxes for SS & Medicare. As it stands they take too big a bite out of middle-class incomes. (Some suggest raising SS & Medicare taxes for the wealthy. But if we do that, we risk losing solid suppport for these programs. In Congress, the wealthy have more power than the rest of us’ some of them already are opposed to Medicare; we don’t want to encourage opposition to Medicare and SS.
    But what we can do, as I suggeste in my reponse to Barry above, is raise taxes on the top 5% as well as on corporations. The top 5% possess a huge share of the nation’s income and of its wealth. That’s where the money is.
    (Some people call for taxing the top 1%. But to raise the money needed, we should cast a wider net.)
    Finally, I agree with you: Canadians are more content than we are. Just one sign of teh difference: Significantly lower rates of mental illness in Canada. And, of course, much less violence.

  14. Barry—

    The notion that Canadians come here for healthcare because the waits time is so long in Canada has been
    debunked. See “Phantoms in the Snow” which was published in Health Affairs.

    Also, reserach shows that when Canadians wait for a knee replacement they also learn more about the odds of success, the long rehab, etc. When fully informed a significant percentage decide — “You know what, I don’t think I want to do this.”
    In the U.S., by contrast, we rush patients into knee replacements without giving them sufficient information about the risks and the odds. Then we are suprised when the operation is not successful and they sue the doctor!.

  15. Maggie –

    You might want to check out the Commonwealth Fund data on healthcare utilization in OECD countries which you can find here: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/May/1595_Squires_explaining_high_hlt_care_spending_intl_brief.pdf

    There are fewer knee replacements per 100,000 people in the U.S. than the OECD median. Germany and the U.S. are tied for the lead in hip replacements though, but Germany’s overall healthcare spending as a percentage of GDP is far below ours. Japan does much more imaging than we do. The U.S. has fewer hospital beds per million people than most countries and a below average number of physician consults per capita.

    On the other hand, hospital spending per admission is considerably higher in the U.S. mainly due to much higher prices per service, test and procedure and prices paid for the most common brand name drugs are 25%-50% cheaper in other OECD countries than here.

    Regarding geographic differences in utilization within the U.S., a recent IOM study shows that most of the differences within the Medicare program relate to post-acute care following a hospital discharge for skilled nursing facilities, home healthcare, hospice care and rehabilitation services. In the commercially insured population, the differences are mainly accounted for by variations in prices paid by insurers per service, test, procedure and drug.

    The bottom line is that pricing for hospital based care and for brand name drugs is a more significant factor in high healthcare spending in the U.S. than you suggest. Defensive medicine and, to some extent, patient expectations also drive utilization of services beyond prudent levels but Democrats are nowhere to be found in finding ways to constructively mitigate the defensive medicine issue through sensible tort reform because they are beholden to trial lawyers and their campaign contributions.

  16. Run 74511 and Barry–

    Run– The subsidy to help pay for premiums and the subsidy to help cover out of pocket expenses is based on Modified adjusted gross income. That’s the number at the bottom of the 1st page of your tax form. It’s “modified” because it’s after you deduct a few things, such as contributions to an IRA, or health insurnace–but only if you are self-employed. .

    Yes, certain countries overtreat in various areas. The Swiss are fond of prescription drugs– a big industry in Switzerland. The Japanese like imaging. And they don’t like surgery. Very few invasive procedures in Japan,and doctors are paid poorly for surgery.

    But when you look at all forms of treatrment the U.S. is at the top of the list.. We over-treat because A) Americans believe anything could and should be cured B) U.S. doctors are trained to believe that they should be pro-active (don’t just stand there, Do something1 and C) the whole system is based on fee-for-service. Do more, and the hospital earns more.

    As the rearchers at Dartmouth have pointed out: American patients spend fewer days in the hospital than Euorpeans, but a LOT More happens to them while they’re there.

    It’s very easy to latch onto one aspect of our healthcare system and say: That’s the problem.

    It’s far more cmplicated than that. Over-payment and over-treatment cannot be separated from each other.

    Finally,we know that tort reform does not change over-treatment. Where it has tried, and however it has been tried, in the U.S., overtreatment continues.

    Conservatives love to beat that drum because they’re opposed to consumers suing businesses for any reason whether it’s absestos, cars that explode when rear-ended, or hospitals that let doctors perform hundreds of unnecessary surgeries.

    Those lawsuits are bad for investors– the corporation loses money and so shareholders lose money.
    Ultimately, conservatives are interested in preserviing the
    wealth of the wealthy (which includes wealthy corporations.)

    When I was at Barron’s and wrote about a defective heart device that Pfizer continued to peddle–even though the company knew it was defective– the stock stopped trading in London, and Monday morning it never opened in N.Y.

    Conservatives were furious with me–and Barron’s. I received hate mail. Do you realize how much $$$ shareholders are losing? (That was among the more civil things they said) The fact that people were losing their lives was far, far less improtant to these readers than that they were losing money.
    They hated the attorney who brought the class action suit. (Ultimately Pfizer settled for an enormous sum.) The attorney and his firm were a good example of what the plaintiff’s bar does.

    But letting the “little guy”‘ (the consumer ) sue represents a threat to wealth. This is why conservatives hate “the plaintiff’s bar”— lawyers who set out to defend those who have little or no power.

  17. My income is fixed at $900 per month. This puts me just shy of 100% of the FPL. I am older and have diabetes and desperately need health insurance. What on earth will I do???

    • Katy–

      You should be eligible for Medicaid. Obamacare calls for expanding Medicaid to everyone under 133% of the FPL.

      Some states are refusing to do this. But when push comes to shove I suspect that all but a very few will go ahead with the expansion.
      Washington is offering to pay for it, and the states, their hospitals and their health care systems need the money. The political pressure to expand Medicaid will be enormous.

      I just hope you don’t live in Texas (the one state that I am certain will not expand Medicaid.)

      • Nope. The Supreme Court struck down the mandatory Medicaid expansion part of the package. States can opt out of the Medicaid expansion. Idaho has opted out. No Medicaid in Idaho for anyone between ages 19 and 65.

  18. Frugal Nurse,

    I did not read every single reply, so if someone already mentioned this then that is great! However, if your income is at $80k and $78k is the cut off, you are still in luck (likely)!!. You just need to decrease your MAGI at $2,000. Easiest way to do this would be to contribute at least $2,000 more to either a 401k or an IRA or FSA (flexible spending account)… but it looks like you have a HSA so focus on the 401k or IRA. By deducting at least $2,000 more into your 401k/IRA.. your income will be $78k. This will reduce you to under 400% of FPL.. and cap your spending at around $7500 (9.5% of your income). This will GIVE you the $9,000- $10,000 subsidy or so ($1400 *12, – $75000). This is a strategy which EVERYONE who is within $10k of the 400% FPL needs to analyze.

    One last point of potentially bad news. You mentioned your son in school, whom I assume is still your dependent. The subsidy is based off of MAGI, which now INCLUDES the income of all members who are dependents. So if your son earned $5,000 this next year, your overall income would be $85k, if you still earned $80k from you and your husband.

    Again, it would still be wise then to fund anotehr $7k into 401k and IRA (hopefully you haven’t reached teh limit of ~$17k per year into an IRA).

    Hope this helps!

    • Matt–

      Thanks for the comment.

      You make a very good point. EVeryone should realize that we talk about the cut-off for subsidies we are talking about Modified Adjusted Gross Income (MAGI) not adjusted gross income.
      MAGI can be lower. So if you’re within shooting distance of the cut-off you should talk to whoever does your taxes about how you can bring your MAGI down.
      Contributing as much as you can to a retirement plan is a v. good idea.

      I really should write a separate post about MAGI

  19. In these questions and replies, I keep hearing about the word “Medicaid” in regards to health insurance. In NY, you don’t qualify for Medicaid unless you don’t own anything. I mean, you cant have ANY assets. No house, no decent car, barely anything in a bank account. For anyone who works and owns any material possessions, forget it….Medicaid was never an option to begin with, so please don’t refer to it as an option.

    • Valerie–

      I don’t know where you got this information on Medicaid. But by spreading rumors and hearsay you upset and frighten people.

      Here are the facts:

      Your home does not count among your assets –unless it is worth more than $786,000. You, or a spouse, do have to be living in the house. (If you are a single person living in a home worth more than $786,000, let me suggest that you sell it, buy yourself health insurance, and move into a smaller home or apartment. http://www.elderlawny.net/id6.html

      Finally if you go into a nursing home or rehab center you can keep the house as long as it seems reasonable assume that in the future you will be released and going back home.

      The last time I checked, an automobile also did not count as an asset.

  20. I’m a single mom in her late 40’s, relatively healthy, don’t smoke and stay fairly active and have a 16 year old at home. Before taxes, I make $21,000 a year. Health insurance is offered at my job but the monthly premium is $400 (just health, not dental or vision) this year, and will likely go up next year; our open enrollment is in December. I pay $500 a month for groceries so I had to chose; health insurance or groceries, not to mention electricity for my small house– so I chose groceries and electricity, the latter of which I keep at a warm 79 degrees but we’re used to it. Heat is nothing new in Texas and this is at least tolerable.

    So if my employer offer’s insurance that I can’t afford on my income but the health exchange costs will be about the same as my office insurance, regardless of which plan I go with, can I still get subsidies? Or will subsidies only play on the ACA plans.

    Also, my son is on CHIPS so he’s taken care of until he’s 18. I suppose after that he’ll have to buy his own insurance through the ACA since he’ll likely be in college. That is, assuming he can find a part time job during college. And what if he cannot work and go to school at the same time to keep his grades up? How can he afford ACA then?

    I live on a VERY tight budget in attempts to keep off the government bank but honestly, even the slightest deviation from my budget that I can’t control (increase in gas prices, electric rate increases, reduction in my modest income from taxes, etc) and I’m sweating the bills on a constant basis. As it is, with the inflation on groceries, when I make a meat-dish, I leave all the protein to the 16 year old and eat just the side items.

    NOTE: PLEASE PLEASE PLEASE no political banter in your reply. I want to deal with my situation not the red state vs. blue state arguments. I just want to deal with the issues at hand and not the peripheral diatribe.

    Thank you,

    • Julie–

      You emailed me with your question and I replied.

      The bottom line is that if the insurance that your employer offers costs more than 9.5% of your income to cover a single individual (not a family), you will be eligible to buy insurance in the state marketplace (a.k.a. Exchange) where you will receive a generous subsidy.

      in this case, $400 a month or $4800 is more than 9.5% of the $21,000 that you earn, so you will get a subsidy.

      If your son earns less than $46,000 a year while working his way through college he too will be eligible for a very generous subsidy.
      Both of my children worked during the summer while in high school and in college. One of them worked part-time during the school year in college. They managed to keep their grades up.

      If your son got a part-time job on week-ends and in the summer now, he can make some extra money and that would help pay for things he wants and needs–taking some of the pressure off you. .. (Unemployment is high, but there are jobs that most adults don’t want to do–like delivering groceries for a grocery store, bagging groceries, working as a bus-boy in a restaurant that a 16-year-old can get.

      The Affordable Care Act makes excellent health insurance very affordable for low-income and middle-income people– you and your son should be okay.

      Finally, both here and in your email to me you mentioned the cost of groceries, and here you mention making meat for your son.

      As you probably have read elsewhere, red meat is not the best form of protein for your son. One reason so many American teenagers are overweight is because their diets tend to be less than healthy. Here is what doctors recommend: pasta with home-made sauces made from vegetables (tomatoes, yellow peppers, etc., chicken with brown rice; )pasta with low-fat mozzarella, fresh tomatoes and basil, beans in soups and casseroles, eggs (omelets with vegetables, cheese souffles), risotto with shrimp and vegetables, small portions of poached salmon or smoked salmon, home-made chicken & vegetable soups, whole grain breads, fresh fruits (rather than fruit juices which are high in sugar), tuna salad, plain yogurt with fresh fruit, low-fat milk, no soft drinks, no prepared foods, no take-out –and you could bring your grocery bill down. (My husband and I eat on less than $500 a month and we love food. )

  21. ? I will make less than 10,000 this year. I am single and in GA.

    No medicaid expansion. Will I be eligible for subsidies or will I have to get a friend to give me a 1099 for extra income ( which of course will be taxable – SS and health) ?

    Thank You

    • Tanja-

      I am very sorry but in a state that does not expand Medicaid someone who earns less than $11,400 won’t qualify for Medicaid or for a subsidy in the state Exchanges under Obamacare.

      When lawmakers wrote the Affordable Care Act they thought all states would be required to expand Medicaid and so they don’t include people earning $10,000 in the pool that would get subsidies in the Exchanges.

      Then, to their surprise, the Supreme Court overturned that one provision in the Affordable Care ACt– the part that says that states must expand Medicaid.

      You can be sure that hospitals and others in Georgia will put great pressure on Georgia politicians to expand Medicaid. The Federal govt will be paying for almost all of the expansion and George needs the money. I would guess that Georgia will in the next two years or so. Some legislators who refuse may be voted out of office.

      But it will be a battle.

      In the meantime, if you can earn extra income to bring yourself over $11,400 you should do that. You will get a very generous subsidy to help you buy insurance in the Exchange

      But you will have to do some sort of work for your friend. He can’t just give you a 1140–or you both could end up in jail.

  22. I have 2 adult children (19, 21) that are currently covered under their father’s health insurance from work. However, he is removing them at the end of 2013 due to an increase in cost. It is cost prohibitive to add them to my health insurance as well. Neither of them are employed. Our 19 year old is a sophomore in college and our 21 year old just went back to college today (after a 1-1/2 year break). How do I calculate what they will have to pay when they don’t have any income? Does my income affect them? I claim the 21 year old on my taxes as she still lives at home. My ex-husband claims the 19 year old on his taxes as per the divorce decree, even though the 19 year old lived with me until he went to school this month. However, I do believe my ex-husband claims him as if he lived with him. Thanks for any information you can give me.

    • Brittney–

      In most cases, the cost of adding a twenty-something to your employer’s health insurance is tiny.This is why millions of Americans have been so happy to be able to add their 20-something to their plan. (Insurers and employers know that twenty-somethings are not expensive to insure–generally they are very healthy. So they have been willing to include them without high extra charges.
      I am very surprised (and very sorry) that in your case the cost is unaffordable with each of your
      But your 19-year-old and your 21-year old both are eligible to buy there own insurance in their state’s Exchange–even if their college offers health insurance, In the Exchanges, they will be eligible for government subsidies in the form of tax credits (even if they don’t owe taxes.) Typically, young adults at their ages will be able to buy insurance in the Exchanges for somewhere between $70 and $125 a month (depending on where they live.) If they work during the summer, they
      should be able to cover the cost of health insurance. (I realize that high unemployment makes it hard to find jobs, but there are still many jobs for young people that most adults don’t want to do-busing tables in a restaurant in an area with high summer traffic, delivering groceries or bagging groceries, etc.

  23. i recently got a new job i bring home 2000 a month after taxes my husband is permanently disabled he has medicare but they just cut his ssi cause of my new job and may cut his medicaid,he only gets 799 in social security .we struggle every month as it is ,i have no health insurance and have serious preexisting conditions,but have not been able to do anything about them since i take care of my disabled husband.i’ll have to choose between food and Obama care.

    • Angel–

      Do you work for someone who offers “affordable comprehensive insurance” that costs less than 9.5% of your income and covers the essential benefits, caps out of pocket spending and meets the other requirements of the ACA?

      If not, you will be able to buy comprehensive insurance for yourself and your husband in the Exchanges (online marketplaces where you can shop for insurance) and get a rich subsidy to help cover the premium. You also will get help with co-pays and deductibles.

      Insurance is these marketplaces is designed to be affordable. If you are buying insurance in the Exchanges, you will not have to choose between food and Obamacare

  24. Question: Can my 20 year old daughter, a college student by health insurance on the exchange and qualify for a subside, based on her very low income. Or, will the income threshold apply to my (father’s) higher income ?

    • Rick–

      If you claim your daughter as a dependent on your taxes, then your household income (i.e. your income) will determine whether she is eligible for a subsidy.

  25. I am retired, but I do not have any retirement income yet. I buy my own insurance. My husband is also retired and gets a pension and can purchase health insurance through the retirement organization. Through the insurance exchange, the cost would be the same, whether only I purchase insurance or we both do, making it more affordable if we can both buy through the exchange. Is the state retirement organization considered his ’employer?’

    • Joann–

      You will have to call your state’s “Exchange” or marketplace with these questions.
      If you tell me where you live, I can give you information on how to contact them.
      (First, you should probably contact your state retirement organization. They should know whether they count as an “employer” and
      whether your husband is eligible to purchase insurance in the Exchange.

  26. are you eligible for a subsidy if you have a small amount of income (let’s use $24,000 annually for a family of three) but you have a high net worth?

    • TMAN4OSU

      Assets don’t count. They just look at income.
      If it’s $24,000 a year for a family of three, you are definitely eligible for a good subsidy.

  27. I am unmarried with a child. My child’s father (35) is a stay-at-home dad. Because he lives with me and does not have any income, I am able to claim him as a dependent on my taxes. He does not currently have health insurance.
    I currently pay for health insurance through my employer for myself and child ($2419/year). My MAGI is about $50,000.
    If I do not claim him as a dependent, he does not have to pay for healthcare nor pay the fine as he would not file taxes. Yet, if I claim him, I have to pay for his healthcare. I cannot find a way to figure out how much it would cost to insure him (or the fine amount if he is not insured) that takes into consideration the amount I am already paying for insurance through my employer.
    If I claim him as a dependent, do I have to purchase insurance for him?
    If so, how much would that cost?
    Would it be best to just not claim him as a dependent?

    • Melissa T.

      Since you are not married, for the purposes of applying for a subsidy or Medicaid, you and your child count as one 2-person household, and your child’s father counts as a 1-person household.
      Your income does not affect his eligibility for Medicaid or a subsidy–as long as you don’t claim him as a dependent on your income taxes. (You should double-check this last part with your state Exchange, but from the research I’ve done I’m quite certain this is correct.)

      It would be worth giving up the deduction to make sure he has coverage. Otherwise, if he gets sick you will wind up paying the bills to make sure he gets good care. I realize he is only 35, hyoncan be in an

  28. I have entered into the WA Healthplanfinder.com website my income, which is very low, but I do have 4 rentals that barely cash flow and mostly run a little negative. I input the gross rental income as instructed, but never was able to input the cost. I am being penalized and not qualifying for the program due to my income being too high. My gross monthly income without the rentals is $2448 plus $168 in dividends. We have 2 adults in the household. Rental income is $3200 so they are adding this in to total income. I never see a penny of this income! How do I get this adjusted? Thanks!

    • Lisa–

      You will have to call your state exchange with this question.
      Income for the purpose of subsidies is “adjusted gross income”

      I don’t know whether adjusted gross income lets you deduct business expenses.

      (Your rentals are a business, and after expenses, they are losing money)

      I would think you should be able to subtract the expenses– but I’m not sure.
      This could be a glitch in the WA Healthplanfinder . .

  29. I think it might, it does ask if on a business schedule reported income, I would consider sch e a reportable income other than personal and perhaps that is where the deduction goes? I will pursue it more. I just do not see how this is fair or logical. But then again it’s a government program!

    • Lisa–

      Yes, I’m quite sure the income and the expenses would go on the business schedule.
      Just double-check with the Exchange, but I agree– it wouldn’t be fair or logical if you couldn’t deduct
      Finally, since you are not making money on the rental properties, why hold onto them?
      Maybe you live in an area where real estate is depressed, but interest rates are still low enough that
      people are buy. When interest rates go up (which they will) real estate prices will fall.

  30. my husband and i receive 28,000 a month in social security my husband gets medicare. ido not . when i applied for assistance they said iwas not eligible. Is that right? I live in ny.

    • Barbara–

      Is Social Security your only income? Are you taking money out of an IRA or 401-k (that also would count as income).
      Are you receiving divdidends (they also count as income.)

      If your ONLY income is $28,000 in Social Security– and if you don’t work for someone who offers health benefits– then you should be eligible.
      I would suggest phoning your state exchange and ask for a person to help you (they’re called “navigators.”)

  31. How will people receive the tax credit for the subsidies? Do they receive the cash or is the money credited to the insurance payments?

  32. I am self employed and gross about $5000 a month. However my expenses to make this gross are very high. I have had to pull money from my 401K in order to make ends meet. Currently I pay $611 monthly for a health plan. The calculator says I don’t get a subsidy because of my $5000 gross. This doesn’t seem logical as my net is about $1500 a month. Am I reading this right?

    • Debbie

      I sympathize. I also am self-employed and pull money out of savings to supplement my income.

      I’m not sure what calculator you are using, but subsidies are based on your modified adjusted gross income–not your
      gross income. Your modified adjusted gross income includes your business income AFTER expenses.
      So you you should qualify for a subsidy.

      Double-check this with your state marketplace. (Get our your 2012 taxes so that you can answer their questions on the phone.
      But I would wait until early November before calling them. Right now, they’re so busy– and still working out computer problems in many states. But it should be much easier to get through to them in a few weeks. You have until December 15 to sign up for insurance that will start January 1.

      • Thank you so much! Do you think I will have to count the 401K money I took out as part of the adjusted gross income?

        • Debbie–

          Yes, money you take out of an IRA or a 401-k does count as part of your modified adjusted gross income when calculating whether your qualify for a subsidy.

  33. My husband is on early social security so not old enough yet for medicare. But based on our wages we do not get a tax credit, we do not make enough,lol we are too poor for a credit! But Oklahoma did not expand its medicaid program, so do we don’t qualify for it either, so do we just fall through the cracks with no help???

    • Sharon–

      In Oklahoma, a person does not qualify for Medicaid unless he or she has dependent children–no matter how poor he or she is. Given your age, I’m assuming you don’t have dependent children. (Oklahoma is one of a number of states that offers Medicaid only to adults with children.

      When Congress passed the Affordable Care Act, legislators set out to fix this by including a provision which says that
      states must offer Medicaid to anyone earning less than the federal poverty level (FPL) –whether or not they have children.
      (The federal government would pay the lion’s share of the cost.)

      This fixed the problem of denying Medicaid to childless adults, and it also fixed the problem in states where people don’t
      qualify for Medicaid because they are poor, but not poor enough. For instance, in some states you qualify only if you earn less than 75% of the FPL.

      When finished writing on the the Affordable Care Act in 2010, everyone thought the matter was settled. Nationwide, anyone earning less than 133% of the FPL would get Medicaid. As a result, the ACA provided subsidies only for people earning between 133% of the FPL and 400% of FPL. They thought people earning less than 133% of PPL would be covered by Medicaid.

      But then conservatives went to the Supreme Court, trying to get the ACA overturned. The Court upheld everything in the ACA–EXCEPT the provision regarding Medicaid expansion. The Court said that state’s didn’t have to expand Medicaid if they didn’t want to.

      Thus, people in states that offer Medicaid only to people earning less than 75% of FPL fall into a “crack if they earn, say,
      80% of FPL–too much to qualify for Medicaid, but too little to meet the 133% threshhold that would make them eligible for a subsidy.

      Unfortunately, at this point Congress cannot fix this. The Court has ruled. The people to blame are the conservative judges on the court.

      In the meantime, you need to hope that ultimately Oklahoma decides to follow the 29 states that have decided to expand Medicaid.
      The good news is that while “Oklahoma: Gov. Mary Fallin (R) rejected the Medicaid expansion in November 2012, but in May 2013 said she would consider an alternative proposal that would use money from the expansion and tobacco tax revenue to help state residents purchase coverage”. Anyone interested in where their state stands on Medicaid expansion as of Sept. 17 2013 should
      go to this website: http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap

      As of late Sept. a close ally of Fallin’s said she had not yet “closed the door” on expanding Medicaid.
      If she refuses to expand Medicaid, the state loses a huge amount of federal money.
      Ultimately, my guess is that she, like most states, will do it–it is just a matter of when.
      . There is no reason not to except that many people in
      Oklahoma hate anything associated with Obamacare. They would see expansion as a victory for Obama.

      Write to Governor Fallin and your state legislators. Join any group that is calling for Medicaid expansion

  34. I can’t believe I wanted Obamacare to pass. I’m a single parent, with an 11 yr old son. and I am unemployed. I rent a room in my underwater townhome for which I receive $ $695.00 a month. I live in California and according to ‘Covered Ca’ because my 2012 Adjusted Gross Income was at $6,381, I do not qualify for the program and/or subsidies and was told to go to Medi-Cal. Guess what??? Medi-cal says that because I have more than $3,000 in property excess ($8,000 combined between to little IRA’s) I don’t qualify !!!!!!! So now I will be fined in 2013 because I can’t afford the normal insurance rates, don’t qualify for Obamacare Subsidies AND don’t ‘Qualify’ for Medi-cal either???? I’m 52 and looking for a position where I can actually afford my mortgage and groceries and to support my child. This new ‘healthcare’ makes no sense…Things were fixed on one side but no-one told medi-cal!!!!
    Anthing I can do??? They did approve my son, just not me…Thank you!!

    • Shai–

      First of all, I’m glad your son is covered.

      Secondly, it seems that you have fallen into a crack that is caused by California’s version of Medicaid– Medi-Cal.

      Under the Affordable Care Act, property is not taken into account when deciding who is eligible for Medicaid. They only look at income. But since Medicaid is a joint state/federal program, it may well be that California is able to consider assets as well as income. You should double-check this by calling Medicaid again. Sometimes when you get someone different on the phone, you get different information. If I were you, I would also Google “Covered Cal” and eligibility.

      Finally, I’m wondering why you are holding onto a townhome that is “under water” (which I assume means that its current market value is less than you paid for it.

      If you are worried about buying groceries for your child, why not let the bank foreclose and rent something smaller? (Given your final situation you might find that you can get assistance with housing)

      Then you won’t have too much in assets, and you will qualify for Medicaid.

      • Maggie,

        Thanks for the reply…
        Yes, I’ve fallen through the cracks…I have been to my local office that handles Medi-Cal and yes, they have a limit on assets, (not primary home) but most everything else. I keep my townhome as I am able to rent a room at $695. currently. My mtg, prop taxes and ins average out about $2100 a month, so after the rent I receive, my mortgage ends up around $1500.00 a month. I have a 3/3 and I can’t rent even a 2/2 anywhere around for $1500. So I am at this point, better off trying to keep the townhome, with the mtg interest reduction at least. So Cal is not a cheap place to live. I had savings from my real estate career and stock market but almost all of that is gone. With my son older, he requires more of my time and I am limited on whre and when I can work. No family here, and his Dad has been AWOL for 7 years. That divorce is how I got into this mess, I bought him out, market dropped, and he quit paying child support 2 years later. Anyway, this is much more info than you should have to read!! Thank you for trying to help, I will keep praying and hope something opens up 🙂 Best Regards, Shal

        • Shal–

          First, If your Ex has any income, you should get the govt to track him down and insist that he pay child support.
          The govt is actually quite good at doing this.
          And when men conceive children, they, liked the mother, have s responsibility.
          I don’t feel that strongly about alimony (When my ex left, I didn’t ask for alimony because I had a good job, was only 32, and knew I could support myself.) But I did insist on good child support.

          Later on, at one point, my husband stopped paying child support for about 6 months. I went to family court and they told him that he had to pay. That’s the law.

          Secondly , Shal you are right– “Cal is not a cheap place to live”

          Since you son’t have family there, could you consider moving? Perhaps to the the Southwest (Arizona, or New Mexico) where rents would be much lower? Or perhaps Colorado or, up North, the state of Washington?

          Finally, I wonder if you are holding onto the townhouse as a reminder of happier times when you and your husband were together.

          Often, when a person is divorced, he/she can’t move on until they make some big changes.
          I recall a good friend telling me- “This house is haunted. You need to get out of here” He was right.

          I don’t know you, and so this advice might be totally inappropriate. If so, I apologize.

          In any case, I wish you well

  35. I have a question. In the state of New Mexico, I am employed by a small employer. They pay for 100% of my coverage and 0% for dependents. It is cheaper for me to buy individual policies for my dependents. Will my family qualify for any subsidy? If so, do you know where I can find that in writing, as I have not found anything. Thank you.

  36. I am employed and have employer paid insurance. My husband is unemployeed and uninsured. For just me, If I pick a particular plan and participate in wellness programs, my monthly premium payment is $0. However, if I add my spouse it will cost $754.00 a month. According to the 9.5% rule that would make the plan “not affordable,” but only the cost of my premium is taken into account, correct? So we would not be eligible for a subsidy?

  37. I appied online for the Affordable Health Care Act as was denied any subsidues even though I am a homeless and disabled. Albeit, I have been applying for disability for 3 years and it still hasn’t been settled so to the gov I may not be disabled but in reality I am. How can a homeless person who’s only real income is food stamps be denied free health coverage?
    I worked my whole life until I had my accident. I truly feel disciminated against as a single white male.

    • Tim–

      You must live in a state that does not offer Medicaid to childless adults. (It doesn’t matter whether you are black or white, male or female. In this states you are not eligible for Medicaid unless you have children.)

      The Affordable Care Act tried to change that. The legislation said that, starting in 2014, everyone living under 133% of the poverty level would qualify for Medicaid.

      But then some states took Affordable Care Act to the Supreme Court. The Court affirmed every provision in the ACA– except the Medicaid rule. The Supreme Court said that states
      didn’t have to expand Medicaid if they didn’t want to.

      The people who wrote the ACA never imagined this would happen. Thus, it made the subsidies that help people buy insurance available only to those who earn somewhere between
      and 400% of the federal poverty level–assuming that those who earned less than 133% of the FPL would be covered by Medicaid.

      So you felt into a crack that they just couldn’t foresee.

      The good news is that over the next year I suspect that most states will agree to expand Medicaid–and if they do that, you will definitely be included.
      The reason I think this is because if they expand Medicaid, Washington will give them a great deal of money. In this country, “money talks” even in conservative
      states. Hospitals, health insures, drug-makers. in the healthcare industry want the revenues they will get if more people are on Medicaid.

      There are a few states that will be hold-outs. Unless Texas elects a governor who is a Democrat (and this is not likely) I’m afraid Texas will continue to refuse to expand Medicaid.

      BUT–since you are homeless and don’t have a job, couldn’t you consider moving to a state that is expanding Medicaid? I realize that you may well have a support network where you live–but clearly it’s not strong enough.

      If you move, you may run into a waiting period before you sign up for Medicaid, but that would be better than having no access to health care.

      Whether you move or stay where you are, you should contact your state’s Legal Aid program to see if a lawyer will help you with a disability claim. Usually, it takes a lawyer to
      move a disability claim along . . .

  38. i dont work my income is my pension and my ss 363.15 and 1448. total is 1811.15 how much will have to pay for the insurance

    • Noreen–

      You should qualify for a govt subsidy. To find out how much the subsidy will be and who much you will have to pay, you should check with your state’s Exchange. (I’m assuming you’re not old enough to receive Medicare. If you are eligible for Medicare, you don’t have to buy insurance.)

  39. I have a question for which I have not been able to find an answer after extensive searching. My three dependent children (ages 15, 13, and 11) receive social security survivor benefits. The monthly check is made payable to me as the surviving parent; however, the Social Security Administration sends an annual Form 1099-SSA for each of the children listing their name, social security number, and the amount of social security survivor benefits they have received. None of the children file an income tax return because this is their only income. HealthCare.gov and many other sites state “Your household income in your modified adjusted gross income (MAGI)(joint MAGI if you’re married), plus MAGI of your dependents who make enough money to have to file a tax return”. My interpretation of this statement is that my children’s social security survivor benefits would NOT be included in household MAGI for purposes of the Affordable Care Act”. Is this correct?

    • Ken–

      You are right–it is hard to find an answer to this question.

      But unfrortunately as far as I can tell, your children’s SS benefits would be counted when calculating your MAGI for the purpose of deciding whether your household is eligible for a subsidy when buying healthcare.

      Under the Affordable Care Act, MAGI includes “non-taxable SS benefits”–and I’m quite sure that includes your children’s SS benefits. You don’t pay tax on them, but they do add to the income that you have available to cover health insurance. See https://ttlc.intuit.com/health-care/1897437-do-social-security-child-and-survivor-benefits-count-toward-household-income-in-this-calculation

      But I would urge you to triple-check this with your state’s Exchange. You need a navigator who is a tax expert–when you call, explain that you have a tricky tax question, and ask for a navigator who specializes in taxes.
      The good news is that as time goes by (over the next month or so) more and more people will be asking difficult questions like this, and more and more navigators will have the answers.

      IF I were you I would also Google “Obamacare” and “Social Security” and “survivors” benefits” and “subsidies.” Over the next month, I suspect you will find more information.

      Finally, try calling the Social Security Administration.

      If, in month or two, you haven’t found a clear answer, please write to me again. I have an excellent tax accountant. Right now, I
      doubt he has an answer. But by then, he is likely to be up to speed on the Affordable Care Act and MAGI.

  40. What was the motivation to make subsidy qualifications based on 100-400% of FPL and not 0-400%. I am a single childless adult and live in a state without Medicaid expansion (South Carolina) and fall under 100% of the FPL so I don’t qualify for subsidies nor do I qualify for Medicaid. Isn’t the whole point of Obamacare to insure those who previously couldn’t afford insurance? It seems like I am the new 1% that nobody is talking about. I’ve not been able to find any info about other people in a similar situation. Does the individual mandate still apply to me? Am I the only one in this gap?

    • Trey–

      When Congress passed the Affordable Care Act, it assumed that all states would expand Medicaid. After all, the Federal govt is paying for nearly the entire cost, and the
      states (and their public hospitals) need the money.
      But conservatives decided to take the Affordable Care Act to the Supreme Court, calling for repeal. The Court didn’t do that–but it did say that the states don’t have to expand
      Since the legislation had already been passed, it was impossible, at that point, for Congress to go back and make the subsidies available to anyone earning 100% to 400% of FPL.
      (Republicans in Congress now had control of the House and would never let the change go through.

      If you can show that you cannot afford a insurance, you will not be subject to the individual mandate.

      The good news: because hospitals and others in the healthcare industry want to see Medicaid expanded, state legislatures and governors will be under enormous pressure to expand Medicaid. Many observers think that most of them will cave in the months ahead. I just hope that South Carolina is one of them!

  41. Hello…

    I am a single 35 year old male living in Chicago, Illinois. I am curious if there are any subsidies that are available for me. I Currently do not work and have been unemployed for over 2 years due to a major back injury that required surgery. My current individual plan thru BCBS gave me permanent restrictions regarding my back. Which means, they will not cover ANY and ALL claims that can be in any way associated with my injury. I even spent about $9000 out of pocket this past year that BCBS would not cover. I need to find a way to afford a new plan with a quality network. Originally, we were told we could keep our plans if we were happy with them. But this is not the case. I have a $1000 deductible with $1000 co-insurance at 80% and I pay $218 a month. I cant get anywhere close to this coverage and pay close to this with the new laws. What can I do to get help? Id really like to stay with BCBS due to the network and doctors available. I was told that there are companies like BCBS that offer major discounts to their premiums based on income. I have no income in 2012-2013. Is there a way for me to receive insurance through BCBSIL at a lower cost? Please help. Ive even filled out the form on healthcare.gov and nothing came of it after 32 days. I spoke with them on the phone and they said Im in the system but there are no results for my eligibility, or lack there of. They are trying to figure it out, but not sure how long that will take. I would love some answers. Thank you.

    • Brian–

      If you have no income, you should definitely be eligible for Medicaid. (In the past, you may not have qualified because
      you had no children. Before Obamacare, in many states, childless adults did not qualify.)

      But under Obamacare, states that expand Medicaid must offer it to All adults, whether or not they have children.

      The good news: Illinois has decided to expand Medicaid. You are eligible. Under Medicaid, you pay no premiums.

      If I were you, I would first ask my doctors if they would accept Medicaid. Since they already know you, and have been treating you, I would hope that your physician they would want to go on treating you, even though Medicaid pays less than commercial insurers.

      If a doctor says “No,” ask him if he can recommend a physician or a good hospital clinic that does accept Medicaid. I am sure that a caring physician will try to help you.

  42. I’m still four years away from Medicare, self-employed and uninsured.

    I’ll spare you the ugly details (a nasty divorce compounded by erroneous financial advice), but the bottom line is that I owe the IRS a substantial amount of back taxes.

    I’m guessing that this, in and of itself, will preclude me from qualifying for Federal health insurance subsidies. Correct?

    Not all that surprisingly, I suppose, my new accountant doesn’t know.


    • Jeff-

      Here is the one good piece of news that I can give you: If you are paying alimony, the government will deduct alimony from your income when deciding whether or now you qualify for a government subsidy to help you buy insurance.

      I have actually read the entire Affordable Care Act more than once. It is long, and it is detailed, but as far as I know there is nothing in there about people owing the IRS money being disqualified from getting a subsidy.

      If you didn’t buy insurance, your penalty (for not buying insurance) would be added to what you owed the IRS.

      But I just don’t see anything that says that you don’t
      qualify for insurance.

      The goal of the Affordable Care Act is to give Everyone access to insurance. That is better for all of us. (Otherwise, hospitals, insured people, and other all wind up paying for the medical care of uninsured people who wind up in ERs.

      The ACA is not designed to beat up people who, for one reason or another, don’t have $$$. And the IRS is not running Obamacre.
      The Department of Health & Human Services is running Obamcare. Conservatives have greatly exaggerated the IRS’ role (This is part of conservative fear-mongering.

      Please check with your state Exchange– call and ask for a “navigator”. But I’m pretty sure that I’m correct You’re eligible for help. .

      • Hi Maggie,

        Thanks for the prompt answer.

        I’m not sure if Florida even has a state exchange, but I’ll Google for one.

        Interesting that the law doesn’t address my not all so uncommon dilemma directly.

        It’s my guess that I am not specifically barred from receiving a subsidy, but that said subsidy would go (as have my annual earned income tax credits) toward my IRS debt. In other words, into a bottomless pit 😉

        • Jeff–

          I don’t know for sure. But I doubt that the ACA lets the IRS eat your subsidies.

          Please let me know.

          If it does, this is something I should write about.

          If it doesn’t, also please let me know.

          I would like to be able to point out the the Affordable Care Act is not controlled by
          the IRS.

  43. Your stated Goal.
    The goal of the Affordable Care Act is to give Everyone access to insurance. That is better for all of us. (Otherwise, hospitals, insured people, and other all wind up paying for the medical care of uninsured people who wind up in ERs. –

    So to avoid all of us having to pay hospital costs we are all choosing to buy everyone health insurance ?

    Anybody want to guess which one is more expensive ?
    The only thing that costs more than healthcare is healthcare insurance. You simply chose to pay more for what we already had.
    And obviously we are all paying for it now anyways so nothing fixed on having to pay for others.

    • james b

      When people don’t have insurance, they put off going to a doctor–even when sick.

      Then, they land in an ER at midnight –in real pain.

      The ER is far and away the most expensive place to get treatment.

      Because they didn’t receive care earlier, they now need far more treatment.
      (Their appendix has burst; an infection has spread. If they had received timely care,
      they could have been treated in a doctor’s office. Now they have to be hospitalized.

      This is why health insurance is NOT more expensive than health care.

  44. How are we going to afford the new high deductibles?
    It takes every thing that my wife and I make to make it.

    Now, we have a high deductible. And the doctor or hospital or whoever we see wants the total deductible before they will see someone. There is no room in the budget for anymore costs in the house hold. The cost of living is already so high. And now health insurance is even higher.

    Health Insurance keeps going up ever year. My pay don’t increased!

    Now I’m forced to have a high deducible before getting treated.

    This means that something isn’t getting paid. If the elected loss enough voters to the cost of living than they will surely be voted out. New and better laws will be implemented. Hoping that Congress will not bust the bubble for the next generation with a dynamic National Deficit.


    • Emmmitt–

      Under Obamacare, there is no high deductible.

      I realize that you have probably read or heard stories in the media saying that, under Obamacare, out-of-pocket costs will be stagger

      This is just not true.

      You will get 32 preventive services without paying a penny- no co-pays, and deductibles do not apply.
      These totally free preventive services incnlude blood pressure checks, cholesterol checks, flu shots, diet counseling,
      help for people who are gaining weight, smoke, or drink too much, as well as screening for a great many cancers plus as a great many vaccines for adults as well as children.

      These 52 free services cover most of the reasons that relatively healthy Americans go to the doctor. They will pay ntohign.

      If you are sick, you will face a co-pay, but under the least expensive Bronze plans, when you are sick and go to the doctor your co-pay will average just $41. If you pick a silver, gold pr platinum plan, you will owe less.

      If you are older or suffering from a serious disease,under Obmacacare you will be able buy a plan that cover 90% of your care.
      There premium will be higher, but deductibles and co-pays will be much lower

      Finally, if you earn less than $29,000 ( or roughly $57,000 for a family of four ) you will qualify for subsidies that slash your co-pays and deductibles. I am writing about this now. In a few days, you see the post here on HealthBeat and on http://www.Healthinsurance.o.

  45. I was looking forward to Obamacare until I spent probably about 10+ hours reading about it /trying to find info about this incredibly complex law/system. I am a seasonal federal government worker that lives in Pennsylvania. I’m married, my wife is unemployed, & last year I made about $14,440, but this year (depending on the hours I’m given before being furloughed &/or laid-off) I might make more or less $… actually, it’s impossible for me to know if I’ll be making a bit more or less $ in 2014. I am offered all of the employer-sponsored regular government Health Plans (hence, I am ineligible to apply for those market place plans). From these plans/options, the least expensive monthly plans are those practically useless High Deductible plans that could cost me about $110/mo (that is the absolute cheapest plan) for an individual and would have a deductible so freaking high that I’ll never realistically realize any $ benefit/help/savings from choosing that sort of plan. Pennsylvania has chosen to not extend Medicaid to its residents, & because my employer offers “affordable plans” (lol, after you spend like $3,000, only then do those HD plans allow you the “privilege” of paying a $60 copay on a single generic med Rx) I am ineligible to apply for those Marketplace plans. Really/ideally, I need a true family health insurance plan, but, this is not affordable (which is why I cringe when I hear the term Affordable Care Act… because neither the individual nor family insurance options I currently have are “affordable”… if we are being sincere here). If you consider 9% of my total family income for a high-deductible plan that realistically pay for nothing anyways to be affordable… then you are not someone I consider sincere. In reality, in my situation, if I had a need for catastrophic care, the state ends up paying for it anyways, so what’s the realistic use of a High-Deductible plan for me? Furthermore, I will be “fined / taxed” because I am not going to be buying/paying for insurance this year. So, what happens to somebody like me under Obamacare? This is what happens: there will not be any affordable care insurance options available to me & my wife; and I will be fined about $150 (which is presumably what 1% of my income will probably maybe be at the end of 2014). I don’t want to hear “oh, well you are a special case that is slipping through the cracks… blah blah” because I hear that excuse far too often when it comes to this stuff. I voted democrat this time because I just couldn’t vote for a job-outsourcing innovator like Romney; but, let me tell you that I am very displeased with the direction of things. How can the government & insurance companies be giving so many Americans so much less (in terms of health benefits/coverage) while at the same time taking so much more from everybody. Yeah sure, a few people might be a little bit better off, however, it seems that a pretty equal amount of Americans are going to be worse off than before (like me & my wife for example). This seems to be the new American slogan: “Pay more & get less”. I guess it’s good that insurance companies can no longer discriminate /deny coverage based on somebody’s pre-existing condition, but, really they shouldn’t have been able to ever start doing all of that nonsense in the first place. Oh, and good luck trying to all my fellow Americans who need to try and find-out any information (especially in any significant detail/depth) when it comes to this Obamacare because you can’t get answers easily (to your/any one individual’s particular situation); in fact there is no one stop / one place you can go to get relevant, true, official answers (e.g., you have to go to the healthcare.gov site first, and then probably go to your employer’s website if they even have one, and then to your state’s website, and then the hunt for necessary/relevant info seems to just goes on from that point to places like this website). I am very disappointed in our health system at this point. Who cares though really right? As long as people in this country aren’t starving to death, nobody is going to do anything about anything anyways (including myself!).

    • William–

      Your problem is not caused by Obamacare. It is caused by the state of Pennsylvania.

      Obamaacare calls for expanding Medicaid. If Pennsylvania did that, you would be eligible.

      You need to elect a new governor–and replace the people in your state legislature who voted against expansion.

      In the meantime, you do need to buy insurance–even if it is high deductible insurance–as long as their is a maximum on how much you can be asked to pay, total, out of pocket. I would guess that your federal employee insurance has a cap on how you can be asked to shell out.

      The reason this is important is because otherwise, if you have no insurance, and are diagnosed with cancer or another disease that requires expensive treatment (surgery chemo etc.) you will not get it. Surgeons don’t take IOUs. Hospitals don’t take IOUs.
      You will die–or you can sell your home and beg $$$ from friends and family to try to cover your bills.

      One goal of Obamacare is to make sure this doesn’t happen to anyone. This is one reason why some policies are being cancelled–they leave families exposed to $30,000 –or more–in out of pocket spending.

      Finally, there is a great deal of excellent info about Obamacare and health care on line. One of my favorite sources is the
      Kaiser Family Foundation. Just Google “Kaiser Family Foundation” and what ever topic you want to explore: federal employees insurance, employer-based insurance, out-of-pocket maximums, Medicaid expansion etc. Their briefs are very very clear.

  46. Having a portion of your healthcare paid for by your employer is NOT A SUBSIDY it is part of your salary-entirely different than the government giving you money that someone else has earned. Orwellian use of language is a perfect example of why this law has so many people so angry. It is a redistribution of wealth….”Hello, my name is Peter, please stop robbing me to pay Paul-my bank accounts are almost empty, and Paul already took phone”.

    • Super Nova–

      Your employer is paying part of your health care bill because it is in his interest that you stay healthy –and don’t miss work.
      He also wants your loyalty–training new people is expensive.
      If you said “I don’t want the healthcare. Please just add that amount to my salary” would he do it?
      No. He is subsidizing your health care because he is getting something in return–less absenteeism, higher productivity, and loyalty.

      The government is subsidizing health care for those who don’t have benefits at work because it is in our interest, as a society
      that everyone be as healthy as possible so that they can be productive. We also have an interest in living in a fair society where everyone, rich or poor, has access to high quality health care.

      Who is paying for these subsidies? People who earn more than $200,000 a year ($250,000 for families) will be paying higher taxes. Health care companies (insurers, pharma etc.) who will be getting millions of new customers also are contributing to the funding. If you earn less than $200,000, you are not contributing a penny.

      Finally, yes, by asking both wealthy individuals and wealthy corporations to contribute we are redistributing income.
      In 1980 we started redistributing income upward by slashing taxes for the wealthy while watching their incomes climb. At the same time the middle-class saw its after-tax income flatten and fall. This went on for 33 years.

      Now, we are beginning to redistribute income in the opposite direction–downward– so that the middle-class doesn’t simply disappear.

      At the beginning of his first term President Obama was very candid that this was what he was going to do.
      He is doing it. And we re-elected him for a second term. The majority of the country favors this approach– and as more and more low-income Americans of all colors vote, I suspect that we will continue to recognize the need to redistribute income.

  47. These numbers are fake. We have a household income of $59,000. We have six people – two adults and four children. We are below 200% FPL. My children are covered under NJ Familycare; husband at work. So I need insurance. My tax credits on the exchange when I applied by phone were $132 a month. My cost sharing: ZERO. that means that I still have the $6500 out of pocket per year max on the silver plan, NOT the $2500 that I should under 200% FPL. I STILL have a $2500 deductible and am responsible for 30% of all costs. I called to find out why i get the tax credit and NOT the cost sharing reduction. Nobody at the 800 number can give me any answers because once an application is filled out, they can’t get back into it. But these numbers are not right. Silver plan in NJ is $430 a month BTW….

    • kel-

      You are mistaken. If you earn less than 250% of FPL , and purchase a Silver Plan you are eligible for two types of cost-sharing subsidies.
      NOrmally a silver plan pays 70% of covered medical benefits–you pay 30% in co-pays and deductibles. But sine you earn less than 200% , you pay just 13% of covered benefits in the form of co-pays and deductibles. The insurer pays 87%. See

      You also qualify for a second type of cost-sharing subsidy that affects the maximum that you can be asked to pay out of pocket over the course of the year.

      In 2014, normally your out-of-pocket maximum would be $6,350 ($12,700 for a family). But if you pick a Silver plan and show income between 100 and 200 percent of the federal poverty level, the maximum you would asked to pay out of out of pocket would be $2,250 ($4,500 for a family). You fit into this category

      Those with income between 200 and 250 percent of poverty level can select a Silver plan with a maximum out-of-pocket of $5,200 ($10,400 for a family).

  48. If someone could answer this I would be very appreciative!

    My wife and I made around 13k this year and are full time college students. We live in Utah and are lead to believe we will not qualify for medicaid because we own a .24 acre lot and the medicaid website says you cannot have assets above 3,000 for 2 people. So we are unqualified for medicaid but below the 100% poverty level to receive subsidies. Where do we go from here? Are we just totally screwed to have to pay penalties without getting coverage? Obama’s silver plan according to healthcare.gov will cost 34% of our little income.

    • Mike–

      I’ve done some research, and you are right, in Utah, a couple can’t have assets above $3,000 and qualify for Medicaid.
      (One source also suggests that in Utah, you might not qualify simply because you are students.)

      Is there any low-cost health insurance available at your university? Even if your university doesn’t offer affordable insurance, is there someone there you
      gives students advice on health insurance?

      It might be worth checking out high-deductible plans. Ordinarily, I would’t recommend them, but in your case, that might be your only choice.
      If you can find a high deductible plan that covers hospitalization that would protect you in case of a bad accident or sudden serious illness.
      But check out the co-pay or co-insurance. If it’s more than 20%, it’s not very good protection. Also ask, what is the maximum we could be asked to pay, out of pocket,
      in a given year?

      Such a policy could protect you against bankruptcy–and protect your parents against a financial disaster if you landed in the hospital and they tried to help you.

      I’m afraid that you’re not going to find a high-deductible plan that covers maternity . . ..

      Finally, if either you or wife is under 27, and your parents have health benefits at work, the Affordable Care Act says that the employer must cover you as well. The fact that you are married does not matter. Your wife could go on her father’s or mother’s plan. You could go on your father’s or mother’s plan. You don’t have to be living with them. You can do this even if your college does offer insurance. Your parent’s premium probably wouldn’t go up by much–if at all. (I’m assuming that the parent already has a family plan to cover himself/herself and spouse.
      Note that your parent’s plan would not cover maternity if your wife became pregnant. But it would cover most other things . .

      Good luck. And when you finish school, you might consider moving to a state that does a better job of taking care of its citizens.

  49. Can someone help me understand how the social security survivors benefit will effect me. My husband die in march and me and our two kids lost his health insurance. Cobra was through the rough i could not afford that. The only income we have is i get the widows SS survival benefits and the girls get their SS survival benefits. We have no other income. How will this effect what we qualify for. Thank you

  50. I just recently finished the online application at healthcare.gov
    but did not get any help on subsidies or cost sharing plan.
    Family or 6 with 4 kids ranging from 22, 20, 9 and 8 with income of $45,000. My two younger one are on CHIP our current insurance Special Care plan is cancelled at the end of the year.
    My eligible letter saying my two younger one are qualified for Chip/Medicaid but there is nothing for the rest of us because our income is higher the Medicaid guide line but no subsidies or cost sharing offer to buy insurance on the exchange?? The health plan cost us over $1200 a month to buy if we want to purchase but how can we afford to buy it without subsidies? I recently found out that Special Care will be extending till June 2014 but then what happen next for all of us? Please let us know what plan we can afford and why we are denied the subsidies to buy new health plan? I called the service rep. but no one can answer that questions or knowing anything about it. Thank you

  51. My wife and I are separated. I live in one state and she is in another. Do we have to get separate policies? The way I understand it, I have to count her income when determining the subsidy. How does our daughter who lives with me fit in? Does her income count if I want a plan just for me. The three of us each make about $15,000. Is my household considered one, two or three. None of us have insurance now because we can’t afford it. Unless the cost goes down it is doubtful we will be able to afford it in the future. My bills already total more than I make. The only bills I could eliminate are cable and cell phones.. I think they are as much of a right as health insurance.

    • Richard S.

      Your total household income determines your subsidy. If you claim your wife and your daughter as dependents on your income taxes, they count as part of your subsidy.

      If the three of you make just $15,000 you will qualify for a subsidy–or Medicaid & Chip.
      for your daughter..

      I’m not sure that we all have a “right” to a cell phone or or cable. (My husband & I actually cancelled our cable a couple of
      years ago, and I don’t have a cell phone.)

      Health care is a necessity–like heat & light. Without it, we cannot survive. A great many people survive, quite happily,
      without cell phones or cable

  52. i want to know which of these states that are offering “subsidies” to unsuspecting applicants on their websites are going to have access to these same applicants “estates” and “assets” after their deaths to reimburse the government for the subsidies over the years…what incentive will their be for a death panel to keep an elderly person alive, if the state (fed govt) is after their assets…I have read about calif and oregon so far…is this applicable in all states that have accepted the expanded medicaid enrollment?

    • Linda–

      There is nothing in the law that allows the government to collect from estates to reimburse the government for subsidies.
      And there are no “death panels”
      I am very sorry that you have been misled by such myths

  53. I retired April of this year. I was going to sign up for my wife’s insurance in Sept, but thanks to Obamacare it would cost an additional $600/mo to get on her insurance. We just barely scrape by. I am not eligible for SS yet. I have a foot problem that prevents me from walking/working very much. My wife only makes $25K per year and I get $23K from retirement. If I have to go on Obamacare, it will bankrupt us.

    • Rick–

      You have been misnformed. Your wife’s employer may have said that he was no longer covering spouses because of Obamacare. But there is nothing
      in the legislation that says that employers cannot cover spouses. (I have read the bill– more than once.)

      But these days a growing number of employers are deciding not to cover spouses for two reasons: a) insurance has become so expensive, and b) when an employer covers a spouse, he gets little in return.

      When an employer covers his own employee he gets something in return: lower absenteeism, and a healthier, more productive workforce.
      When he covers children he gets something in return: employee loyalty and lower lower absentesim (mothers, in particular, will stay home from work to care for sick children.

      Most women do not stay at home to care for a husband unless he is extremely ill.

      These days, in most families, both the husband and wife work, and employers feel that each spouse’s employer should pay for him or her.

      In your case, you have decided to retire early–for what sounds like a good reason. But it is not up to your wife’s employer to subsidize your early retirement. (Though if he wanted to, under Obamacare, he could)

      But I do see a solution to your problem: –you say you have a foot problem that prevents you from working/walking. This means that you should be eligible for disability under Social Security. That would take care of your financial problem

      Do apply for disability. If it doesn’t work out, I would urge you to look for a physical therapist who could help you go back to work.

  54. I have a family of four- myself, my husband, and two teenage kids. My children are covered under their biological father’s insurance so I only need coverage for my husband & I. Our yearly income is roughly $65,000 per year. According to the government website, my husband & do not qualify for subsidies if we do not add the children to the policy (per the calculator, I did different scenarios). So when Obama Care touts that you will receive subsidies if you are a family of 4 with less than $95k per year, this only applies if all 4 are added to the policy? I find that greatly misleading, please tell me if I am wrong.

    • Michelle–

      The fact is that you are paying for insurance for just two people.
      So it’s not clear why the government should give you a subsidy that is designed to help you insure four people.

      The subsidy is meant to ensure that a family of four can afford insurance for four people–we don’t want kids to go without healthcare.
      But your kids have healthcare.

      What the president said is not misleading–you are unusual situation. Is is very rare to have someone other than the parents paying for their kids’ insurance–especially when the mother has remarried.
      (You’re lucky that your divorce agreement provided this protection for your kids! )

      If your ex-husband stopped insuring them and you had to pay for their insurance, then you would qualify.
      But even after you subtract the subsidy, insurance for four might well cost you more than insurance for two–especially when you add in
      co-pays and co-insurance (for the teens) to the premium.

      And your ex might not want to (and might not be able to) stop insuring your kids. Much depends on what the divorce decree says.

      Finally, you should be aware that when it comes to calculating your household income, and whether you are eligible for a subsidy, you
      should be aware that if you receive an alimony from your ex, that counts as part of your total household income. (Child support does not count)

      I hope this helps.

  55. My job is offering health insurance for about $50 biweekly I make only 9,563 a year. Would Obamaplan work better for me, instead of my jobs plan?

    • Jill–

      Go to LocalHelp.healthcare.gov. and you will find people in your town who will help you. They can tell you if you
      are eligible for a subsidy to help you buy insurance

  56. I have been in support of the Health Care bill for years, but I am disappointed now that I actually am trying to sign up for health care coverage. I am in an unusual situation in that I am an American citizen (single, in my thirties) who has lived overseas for 5 years and had to return to the U.S. sooner than expected because of a family emergency. I am currently squatting with a sibling in Florida, while my permanent address is with another relative in Georgia. My overseas income for a job I can do online was low but covered my cost of living in the country I lived in but will not cover my expenses here if I do not squat with someone. It is so low that in the U.S. I do not even have to file for taxes. Unfortunately, when I went to the healthcare.gov website, in neither Florida or Georgia am I eligible for Medicaid and in both states the lowest bronze plan with a $6300 deductable is $195/month, which there is no way I can afford right now. I chatted with a healthcare.gov representative, and he basically said that I could probably be exempted from paying the penalty for not having insurance, but that it looks like I can’t be covered. He did say that I could check out community health centres, but last time I was in the U.S. I did check them out, and you have to have proof of residence through a utility bill or something similar, which is difficult when you are in an unstable residential situation between states like I am. I am fairly healthy and should be ok for a while without insurance, though there were a few issues I was hoping to have checked once I did have insurance, but I am sorry that there are so many cracks for people to fall through. I have been a strong supporter of the bill because I think health insurance is an important thing to have (I did have international health insurance, but it does not cover me while I am in the U.S.)

    A bit disillusioned…

    • tm

      I’m assuming that you don’t qualify for Medicaid because you are a childless adult.

      For that, you can’t really blame “cracks’ in Obamacare. Congress voted that all states would have to
      expand Medicaid (to include childless adults among others who had been excluded.)

      You should blame the Supreme Court for letting Florida and Georgia ignore the law.

      I am very sympathetic to your plight, but it is, as you say, an unusual situation. So don’t be disillusioned about Obamacare, just figure out how to take
      care of your situation.

      In my experience here in NYC the community clinics are very sympathetic. If you brought a note from your sibling saying you are staying with him and one of his utility bills, I suspect they would see you They certainly understand the hardship that the state’s failure to expand Medicaid is causing.

      You would definitely be exempt from the penalty, but you should try to make sure you have access to health care, and I think the community clinic is your best bet.
      (Ultimately, you should try to settle in a state that has expanded Medicaid..

  57. I don’t understand why obamacare uses “one” criteria (the percentage of the poverty level) to determine affordability for each and every person in the United States. You could be making too much to qualify for a subsidy but still not be able to afford insurance. (Example- if you live in a high cost of living state like California….rent for a cheap studio/1 bedroom apt can cost well over $1000. The same place may cost $300 in a lower cost of living state but they are treated the same).
    Also, if someone lives paycheck to paycheck (which many do nowadays) and you take every last dime for health insuranace. That leaves NOTHING left for retirement savings, emergencies like car repairs, ……..etc…….. That person would go bankrupt anyway so in many cases they would be better off saving the money, paying for office visits out of pocket. Even when someone could afford the monthly health premiums but have nothing left over, they couldn’t afford 2-5 thousand deductibles if anything serious came up.
    You say the premiums can not be more than 9.5 percent of income but that’s actually a higher percentage of take home pay (after taxes). That’s what really should count. Also, when you include all the copays, drug costs, and deductibles…….looks like the government is expecting the average person to pay upwards of 20 plus percentage of net income on health care. ……it’s like we’re all just living and working for health insurance.

    • Peggy–

      I agree that a family of four earning $92,000 in one part of the country has more disposable income that someone
      earning $92,000 in a more expensive area.

      But I live in Manhattan–about as expensive as it gets–don’t qualify for a subsidy and I can afford insurance– as long as I live on a budget and set priorities.

      The insurance takes a huge chunk out of my income. But I chose to live in a very expensive area of the country– that is
      my choice. Like everyone, I set my own priorities. I would rather live here–even though we can rarely afford to go out to dinner, or go on vacations. At the same time, even before Obamacare, insurance was, for me, a top priority. So I paid a large sum
      for insurance (doctors and hospitals are also very expensive here) and cut back on vacations.

      In addition no middle-class person is expected to pay 20% of innome on healthcare.

      You are expected to pay no more than 9.5% of modified adjusted gross income.

      And out of pocket spending is capped so that no one will go bankrupt because they have $30,000 in medical bills.

    • Sherry–

      Thank you–

      I will continue to write about the subsidies– who is getting them, how much they are, how much young Americans are paying after
      subsidies; how much older Americans are paying after subsidies

  58. I am primary breadwinner under 15,000 yearly. My husband works very little due to health issues. Two kids young, adults (20 & 22) in college on student fin-aid and very little income. Altogether the 4 of us under $20,000 per year. Kids are also our tax dependents. My husband & I qualified for Wash Apple Health which is Medicaid. But not the kids. I thought they could be on our insurance if under 26 w/ little income? Should they be signing up on their own even though they are on our taxes? Just wondering.

    • PJ–

      If you or your husband had health benefits at work, your kids would be eligible to join that plan up to age 26.

      But since you don’t, I’m sorry to say that can’t get that benefit.

      I don’t know the rules under Wash Apple (Wash’s Medicaid,) but I am assuming that you have already looked into it.

      My best advice: if their colleges don’t have any low-cost health insurance, they should look into the cheapest “Catastrophic Insurance” in your local Exchanges’s market. This coverage is available only to people under 30.

      With Catastrophic coverage they are not eligible for a subsidy, but it would protect them (and you financially) if they were in a terrible care accident.

      Finally, they should definitely check to see if they can sign up on their own in the Exchanges.
      Since you claim them on your taxes, your total household income would determine whether they qualify. . .

      Generally, children can sign up for “Kids Only” plans in the Exchanges that do not include parents.
      But they may too old to qualify.

      When did you last check to see if they qualify for Wash Medicaid? Given their ages, they may be able to apply and qualify on their own. . .

  59. Confused…attempting to sign my ex-wife up for federal healthcare. Her income in 10990.00 gross yearly and the cheapest plan we found of the 18 listed was around 350.00 monthly in premium payment. In terms of her subsidy will she pay the entire monthly premium amount throughout the year and basically get refunded with the subsidy calculated into her tax return at the end. It’s fair to say she is a little worried giving half of her monthly income to an insurance company and if that wasn’t bad enough still have to foot the bill for around 40% of the billings up to a little over 6000.00.

    • Joey–

      I have some very good news for you.

      She doesn’t get the subsidy when she pays her taxes at the end of the year.

      Beginning this January, the government will be paying the subsidy directly to her insurer, each month.

      Secondly, if she earns only $10,990 yearly, there is no way that she would be asked to pay “a little over $6,000” out of pocket.

      Each month, she will be billed only for the remainder (premium minus subsidy)

      And if she actually has income of only $10,990, she should be eligible for cost-sharing subsides that would cut her total out-of-pocket spending by 50% –more more. When I think about it, she should be eligible Medicaid . . .

      If you email me with her facts (age, where she lives, how many people in her household, and actual total income) I could direct you to solid info as to how much she would have to pay. (maggiemahar2@gmail.com)

      Joey, something about your story just doesn’t add up . . .

  60. I am self-employed (no employees) and I make around $85,000, adjusted to around $57,000 after deductions, etc. Until yesterday, I had catastrophic insurance through Anthem Blue Cross, with a high deductible I could never meet in a year’s worth of health-related costs, but at least it gave me a cap on how much I would pay if I had a catastrophic health problem. I paid $344/month for that coverage. Under ACA, I do not qualify for a subsidy and the cheapest plan I could get on costs $570 a month for exactly the same catastrophic coverage I had before. That is not affordable care, it’s a giveaway to the health care industry – blackmail even. There is no cap on what they can charge, even though they have to cover anyone who applies. From what I understand, there are quite a few people in my position. At this point, I’m looking at no health coverage and paying a penalty.

    • Pam N–

      AS a single person earning $85,000 you make more than roughly 85% of your fellow single Americans. $570 a month is considerably less than 9.5% of your income. (Congress decided that 9.5% is an “affordable amount” for people to pay toward their health care. In Europe, many pay 10% (in taxes) to support universal healthcare.
      IN addition, because you are self-employed, you are able to deduct that premium on your income tax.
      Bottom line, your are much better off than the majority of Americans–both pre-Obamcare and post-Obamacare,

      In addition, the Castastrophic plan you are getting in the Exchange is probably much better than the Catastrophic plan you had — in terms of benefits and consumer protection.
      And probably the deductible on your old plan was much higher.

      In any case, under the ACA we are all pooling our money to help pay for everyone’s care. Your premium may be a higher, in part, because you are now contributing to a system designed to make sure that all Americans will have healthcare–including people who are older than you are, sicker than you are, and poorer than you are.

      You may not like the idea, but the majority of Americans decided that we did not want to be the only developed world that doesn’t provide high quality health care, as equally as possible, to all. That is why Congress passed the ACA. Despite doubts and confusion about the ACA American voters then re-elected Presdient Obama. The Supreme Court ratified the ACA.

      Finally the latest CNN poll shows that despite the computer glitches and all of the bad publicty (some untrue) 50% of Americans either “approve of Obamacare” or “wish it were more liberal”

      If you decide to pay the penalty–Good Luck!

      If you are diagnosed with cancer, are in a bad care accident, or fall & are badly injured, you will not be entitled to free care. (You can go to an ER, and they will “stabilize you”
      so that you can walk out the door–even though you don’t have insurance. But they won’t provide the surgery, chemo, radiation or other treatment that you may need.
      And they will send you a very large bill for “stabilizing you.”

      At that point, you won’t be able to buy insurance anywhere either inside or outside the Exchanges until another enrollment period rolls around– in Nov of 20l4.

      As you can see, by going without insurance, you’re taking quite a gamble.

  61. I think your calculations are way off. In California even a single person on unemployment making roughly $21,000 a year will not qualify for any subsidies. A 58 year old woman, unemployed will pay for catastrophic coverage a monthly premium of $483.00!! This does not cover any visits to the doctor until a deductible of $5,000 is met.

    This means if this woman gets sick with bronchitis she cannot go to the doctor, get treated and get a prescription. She will probably end up with pneumonia and run to the ER where her bill will then exceed the $5,000. How can someone making unemployment afford to pay these inflated premiums and still have money left over to pay out of pocket at the doctors???

    Obamacare IS NOT affordable health care and it is NOT health care for everyone. It IS a living nightmare.

    • Becca– You are mistaken.

      I hope you are not deliberately trying to spread misinformation.

      First, in all of California, under the ACA, everyone gets two doctors visits–for treatment– BEFORE PAYING A PENNY OF THE DEDUCTIBLE>.

      Secondly, under ACA, a single person earning under $45,000 qualifies for a fat subsidy.

      Why are lying? Or are you just unable to read? Assuming you can read, go to http://www.healthcare.gov, select California, and your county and your age.
      When you get to the menu of plans, click on details for each plan.

      Then I hope you will write back and acknowledge your mistakes.

      If you don’t, we will all know that they were not honest mistakes– you are simply a Troll

  62. question from Paula,
    I live with my man for 8 yrs, we are not married. I can not get affordable health care because I am in the medicaid area and my state did not expand. I helped him sign up and he gets a silver plan for 189$.
    While looking at info I read you should put down the people in your household and unmarried partner was a person that should be added to [family?]. I see nothing on this site or others that would confirm that I could be added to a family plan if I am not married. If I could I am afraid that if he added me to his ‘family’ it could make his/our coverage ‘unaffordable’. [I was offered a bronze plan for 512$ [over 40% of my income silver was 70% of my income].
    I tried the ‘chat’ but never get a straight answer. {it says income is not a factor for coverage & if I am not eligible on my own that I will not be eligible in other plan.} It keeps referring to citizenship. I am qualified for all but income as I do not make enough for tax credits.
    We would like to understand how this works before he tries adding me to his ‘family’ as he just got his coverage and we do not want to mess up his only to find it will not help me.
    I hope someone answers as I have yet to find an answer and it would seem to be a good question due to fact there are many unmarried partners that need this clarification.

    • Paula–

      It’s a somewhat complicated situation.

      You really need to call your Exchange (don’t use the online “chat”) and ask to talk to a navigator.
      As they have gotten more experience they are more and more helpful.

      (If the first person you talk to isn’t able to answer your questions, just say “thank you” hang up, and dial again.
      You’ll get someone else. (Sometimes I do this when calling customer service.)

  63. I went last night to the website, I live in VA and they didn’t expand medicaid, and came up with my cheapest plan betting 215 a month, for just me (my two daughters get medicaid), my most expensive being 2500 a month… And I make a whooping 12000 at most a year, so I was sure I was doing something wrong, and thought I would call the number, got through quickly and the guy was super nice (a huge plus)… We did it again, at 12000 and got the same so we played with the numbers and went the low end 10000 a year, 198 a month cheapest most being 2350… The guy was surprised and I was like well that stinks.. I’m taking the fine, I can’t afford an additional 200 dollars a month, not when the price of groceries and my multiplies keep going up…So yeah I’ll my the “shared responsibility tax” to give other insurance even though I can’t afford it for myself.

      • Virginia didn’t expand Medicaid, was all the guy on the phone could tell me, I was surprised b/c I bring home around 1000 a month sometimes less.

          • So I should be punished b/c the state I live in didn’t expand and have to pay for other peoples insurance, yeah that makes perfect sense

          • Ginger–

            You are not being punished. And you are not paying for other people’s insurance. (The subsidies are being financed by companies in the healthcare industry plus
            people who make over $200,000 a year.)

            If you can afford to buy insurance on your own (which you probably can’t) then you would be putting your money into an insurance pool that would help pay for healthcare for everyone in the pool. That is the only sense in which you would be paying for other people’s insurance.
            And they would be paying for your insurance. It’s all about “sharing” risk.

            Here is your real problem: You fall between the cracks because Virginia didn’t expand Medicaid. You should try to vote out politicians (probably mainly Republicans) who made this decision. You should band together with other people who favor expanding Medicaid –write to your governor and Congresspeople, write letters to the editors of your newspaper–get involved.

            The Obama administration cannot do anything to force Virginia to expand Medicaid. The citizens of Virginia are the only ones who can do anything–by
            voting your representatives out of office.

  64. So, because Va didnt expand Medicaid, then we get screwed? I make $33000 and was told the cheapest plan I could get would be $450 a mo. I cant afford that! I cant even afford close to that. A wife and a 3 yr old I am taking care of. I would have to give up everything in life and only pay my rent and health care. Where is the affordable in that? There should be NO cracks for people to fall through giving that there was chance after chance to soft roll this thing out instead of making it law by the first of the year. I am going to have to pay the penalty. I cant afford health care through my employer or this crap exchange. I supported Obama and still do, but this health care roll out should have been handled better than this.

    • Decourcy–

      Since you make $33,000 you qualify for a good subsidy that would cut your premium.
      After the subsidy, you would wind up paying roughly $1,150 A YEAR (or 5% of your income)
      in premiums. See https://healthbeatblog.com/2013/07/under-obamacare-will-you-receive-a-subsidy-to-help-you-buy-your-own-insurance-we-now-have-real-numbers-
      that-will-let-you-calculate-how-much-you-will-receive/ for an explanation of who qualifies for subsidies and how they are calculated.

      (Btw I’m assuming that your wife doesn’t work and that your only income is the $33,000. If she does work, you still might well qualify.

      I don’t know where you got the bad information that you would owe $450 a month– from
      an insurance broker or an insurance company??

      Go to http://www.healthcare.gov, scroll down to your state and then scroll down to your county. Indicate that you are
      looking for coverage for 3 people. Scroll down to your ages–and you can then go to a menu of plans that would be available to you.
      (You don’t have to apply– you can see the menu first)

      Then call your Exchange to apply for insurance and for the subsidy.
      Ask them if, in addition to a subsidy that would cut your premium, you might also qualify for a subsidy that would reduce your
      deductible and co-pays.

      If you have any problems, you can e-mail me at maggiemahar2@gmail.com, tell me your ages and what county you live in. And please confirm your
      total household income. I’ll then go on healthcare.gov for you and send you a link to the results.

  65. Hi, my son is a sole proprietor in Brooklyn. he signed on to Medicaid with coverage that starts Feb 1st. His take home pay for this year was within the guidelines for Medicaid, but now doing his taxes the business made about 10k in profit, so he really made 23k.
    He would prefer to buy a plan and have it subsidized, because he likes his doctor (has always just paid cash) and the doctor doesn’t take Medicaid.
    The question is this: can he cancel the Medicaid and go on the exchange and get a plan? How does this work? Is there a time frame to adhere to, and also is it hard to cancel the Medicaid, or perhaps he doesn’t have to, and can just go on the exchange and put in the 23k and shop for a subsidized plan? Please advise and thank you so much.

    • Hi Marie-

      He should call Medicaid, explain that his income was higher than expected, and cancel. Since the coverage hasn’t started yet,and they
      haven’t paid for anything, this shouldn’t be a problem.

      Then, yes he can go to the Exchange where he should be eligible for a good subsidy.
      But tell him that, before enrolling, he should call his doctor and ask him which plans he takes.
      Or, your son may want to pick 5 or 6 plans, and then call the doctor and ask if he takes them

      Since your son will be eligible for a good subsidy, I would urge him to look at “Silver plans”– the premiums are a little higher
      than Bronze plans, but the coverage is better, and most importantly, his income may mean that he qualifies for a “cost-sharing subsidy” that
      will lower his co-pays and deductible as well as a “premium tax credit” that will lower his premium. (Cost-Sharing subsidies are available ONLY if you buy a Silver plan.

      For help using the New York state online Exchange and for more information on subsidies, he should go to https://localhelp.healthcare.gov/
      There he just needs to plug in his city or zip code and he’ll get a list of organizations with phone numbers that he can call for a “navigator” who will
      have all of the information he needs.

      (I’m also in N.Y.C & self-employed. When I shopped the Exchange, I called them. They said someone would call me back within 24 hours and they did!
      The person I talked to was very knowledgeable and very helpful. ) If the first person he talks to isn’t terribly helpful, he should just try another organization.

  66. I entered a scenario on the ACA site where a 57 year old couple is living in Hidalgo County in Texas and making $10,000 year and the following message displayed:
    “Living in Texas in Hidalgo county and based on a household size of two and household income of $10,000:
    Not eligible for help paying for coverage
    This person or household is probably not eligible for help paying for health coverage.

    However, you can view the prices of private health plans available through the Marketplace.”

    I do not understand how this response was given. Please advise.

    • The problem is that the state of Texas has refused to expand Medicaid. As a result, in Texas, adults who don’t have children are not eligible for Medicaid–no matter how poor they are.

      The Affordable Care Act called for expansion in all states, and so legislators assumed that a couple in Texas earning $10,000 would get Medicaid.
      For that reason, the law says that only couples earning over $15,510 would be eligible for subsidies; those who earn less are supposed to go on Medicaid.

      But after the legislation passed the Supreme Court ruled that states don’t have to expand Medicaid. It’s up to them.

      Texas decided not to expand Medicaid and so a couple that earns less than $15,510 is left out in the cold–no Medicaid, and no subsidy to help buy insurance in the Exchange. They fall between the cracks. This is extremely unfair.

      Ultimately, I am hopeful that all–or almost all–states will Expand Medicaid. Though Texas will be among the last.

      Congress could decide to revise the ACA to provide subsidies for people who live in a state that didn’t expand Medicaid. But that would encourage states to
      continue to refuse to expand a badly-needed program. . .

  67. Family of 4 Myself , Wife, 2 children. I am employed $60,000/ year income. Wife is not employed. Myself and children are covered under my employers health plan. Employer does not offer Health insurance for spouse.
    After completing Healthcare Marketplace application wife is not eligible for any tax credits/subsidy. Cost of lowest Silver plan in NJ is about $340 a month. Why isn’t wife eligible for any tax credits/subsidy when Income limit for Tax credits for Family of 4 is $94,200? Thank you for your time.

    • Paul B.–

      Unless I’m missing something here, your wife should be eligible for a subsidy. The subsidy is based on household income and since you are a family of four earning $60,000, she should qualify.

      Contact https://localhelp.healthcare.gov/–just plug in your zip code and you will get a list of organizations that are helping people navigate the
      Exchanges– along with phone numbers.

      Call and ask them to explain why she isn’t eligible for a subsidy. (If the first person who talk to isn’t helpful, just try a different organization.)

      I would be very interested in hearing the answer.

      Btw $340 for the least expensive Silver plan to cover one person sounds pricey . . Unless she is in her 50s or early 60s.
      (Under Obamacare, carriers can charge older Americans 3 times as much as they would charge a 20-something. Though this is an improvement; pre-Obamacare,
      insurers in most states could charge older Americans 5 times as much.)

  68. I’ve been trying to get affordable healthcare for my family since November. Healcare.gov completely screwed us for a number of reasons. First, I signed up and paid premiums for a family plan only to find out that they denied coverage to my two young children. Tens of hours of talking with .Gov and Blue Cross representatives left me with the option of filing an appeal which would take 3 months for a response. I ended up cancelling my plan, forfeiting my premium and sought insurance outside of the website. The second thing that .Gov did was lose all of my information. Every single time I called, they couldn’t pull up my application without going to tier II support and even then it was hit or miss on whether they would be able to keep the data on their screens. They didn’t have any provision for going into the database to fix the problem and multiple times told me to call back and try another representative.

    Moving on to non-government insurance, I found that every single plan was more expensive than through the Marketplace. Blue Cross was 47% more expensive for the same coverage.

    As far as subsidies go, you cannot physically submit an insurance application through the CIGNA website if you selected the option that says you would like to be considered for a subsidy. They don’t tell you this up front and it’s only after you have entered all of your family information and got to the end, you find there is no submit button and call the help line who tells you that you have to go back to the Marketplace.

    I just did some research at the IRS website and you are not eligible for a subsidy unless you get your insurance through Healthcare.gov. If I do go through Healthcare.gov, my children are put on Medicaid. If I don’t, I end up paying $12,000 dollars more a year to keep my whole family in the same plan. If my family members are put on Medicaid, the government will go after their assets upon their death for any medical expenses.
    This whole thing is the biggest disaster that I have ever experienced. There is no asset test for Medicaid so a multi-millionaire with a private island will have his kids put on Medicaid if he lives off his savings and doesn’t draw a paycheck.

    • Okay-let me get this straight.

      You’re worried about what will happen to your children’s assets after they die?
      Are you expecting them to die soon?
      Are you concerned that you won’t be able to inherit their assets?

      • First of all, I already paid the full premium for a family plan. They denied the kids so to put a child on Medicaid would encumber them with tens of thousands of dollars in debt owed to the government. Why should I be forced to do that to my kids when I’m already paying the full ride for a family of 4? It’s like the whole system is geared towards making as many citizens as possible dependent on the government for their existence. The report that came out last week stated that 2.5 million additional people would not be working because people will realize that they don’t have to work in order to keep their health insurance. That’s 2.5 million new dependents on the working class. It’s not sustainable.

        • I just spent another couple of hours trying to complete an application for my wife and I. After entering 80% of the information the website crashed. I got back in and had to re-enter approximately 50% of the information then edited my income because if you select “one time payments” the site interprets the income as monthly. When I changed the one time payment to a monthly equivalent, I was forced to re-enter 50% of the data again. I got all done, viewed my eligibility results and when I selected to option to continue with picking coverage got an Error ID 500.301559 and was kicked out. Logged in again and same result. Went to online chat, waited 10 min and was told to call the help line. Ten minutes on hold and the assistant hung up on me.. Called back, waited another 10 minutes and the new assistant can’t find me in the system. I’ve already given her my name, address social , phone number, … This is what I deal with every single time I’ve tried to acquire coverage.

          • Glenn–

            I have now gone online and checked out insurance for dozens of people in many Exchanges– no problem.

            I have applied for insurance in the New York Exchanges– no problem.

            All of the news reports say that most people are now having little or no problem signing up.

            I took me about 10 to 15 minutes to enter all of my data– so having to enter it 50% of it again would have cost me
            about 7 minutes. Not a big deal.

            I would suggest that you go to https://localhelp.healthcare.gov/ insert your zip code and call one of the phone numbers for local help in your area.
            Whenever I suggest that people do this, they write back and say “thanks–that worked.

        • Glenn–

          No that’s 2.5 million part-time and full-time jobs that will be available to the unemployed and underemployed.

          If some of these 2.5 million receive subsidies those subsidies will not be paid for by the Working Class or the Middle Class. The subsidies will be paid for by people earning over $200,000 ($250,000 for a family) who will be paying somewhat higher taxes to help fund the subsidies. Insurance companies and drug-makers also will help fund the subsidies.

          Republicans have tried to “spin” this story as bad news about Obamacare–and clearly you fell for it.
          It’s good news– people who were close to 65 and stuck in jobs they hated while waiting to turn 65 and become eligible for Medicare now can retire earlier (or partially retire) and make room for younger workers.

          What you are saying about Medicaid makes no sense.

          Your children are on Medicaid (which is free) because your income is low enough to qualify them for Medicaid.
          The funding is separate from the funding for subsidies—and for that reason we don’t want to use the subsidy money for people who qualify for Medicaid.

  69. My annual income for 2013 is $63500. I am working here on work permit H1B for small IT consulting firm
    We are three members in family. My wife is Homemaker.
    We have daughter of age 5 years. My employer is charging $1200 per month as health insurance. Employer is not paying anything towards the insurance.
    Can I eligible to apply for Obama care and subsidy?

  70. Since each and every considered one of the rating entities employed different ranking criteria it could be helpful on the consumer if another entity produced a ranking based mostly for the composite of those five rankings. Considering Paul Ryan’s proposal, by which a great deal of your money choice will be shifted on the patient, value = quality/price need to also be offered as being a separate ranking.br/ Erlo Roth, MD, MBA

    • vanboy–

      Ryan’s proposal would as you say “shift the responsibility” to the patient–a layman, not a medical researcher, who is not in a position to evaluate the quality/price equation.

      The is why we need the ACA which lays out the rules for what all insurers must cover and makes it easy for consumers to do the one thing they
      are in a position to do: compare prices. Because the plans are all essentially the same (must cover the same essential benefits and follow other rules) the consumer can then make an apples-to-apples comparison.

      What the consumer is not in a position to do is to compare the quality of coverage, figure out what is “essential” –and guess what he may need down the road.

  71. I have a daughter that will be coming off our insurance
    as of May 31st. Her employer does not offer healthcare.
    Her yearly salary is under $10,000 right now, but hopefully
    will improve in a year or two. When she went on the site
    it said she doesnt make enough for insurance so has to go
    on medicaid. Someone said it goes by the household income.
    That can’t be right, if she’s not a dependent for us. She just lives with us. Is she still entitled to medicaid?

    • Kathy–

      Yes, she should be eligible for Medicaid.

      As long as you don’t claim her as a dependent on your taxes, she is not considered part of your household.

  72. I live in CA with my boyfriend, his mom and brother. I am unemployed, 49 yrs old, and believe that I have Inflammatory Breast Cancer, though I’ve yet to see a doctor because of no insurance. My boyfriend makes around 60,000 yr as a self contractor and supports me 100 percent of the year. He could claim me as a dependent, but hasn’t yet. Do I qualify for Medi-cal and if so, would full cancer treatment be covered?
    If he claims me as a dependent, would full cancer treatment be covered on one of the cheaper plans?
    In your opinion, which route would be the cheapest option with the most benefit?

    • Jackie–

      Since your boyfriend doesn’t claim you as his dependent, you will qualify for Medi-Cal.
      You earn too little to be eligible for a subsidy in the Exchange

      Yes, Medi-cal should cover the full cost of cancer treatment. (There might be co-pays; I don’t know all of the details
      of Medicaid in California). But without question, you should see a doctor as soon as possible.

      Your chances of surviving breast cancer depend on whether or not it spreads.

  73. My husband receives employer sponsored insurance for himself as part of his benefits. Our household income is $55,000 but for my husband to add our children and myself to his policy at work will cost $12,000 per year. We cannot select a cheaper employer plan and have been told by Legal Aid navigators that we are not eligible for a subsidy on the marketplace. The ACA law considers this healthcare “affordable” because my husband’s is paid for. It does not seem to matter that this will cost nearly 20% of our household income just for health insurance premiums. We have always been able to obtain health insurance for our family until now. How is this affordable?