Subsidy Credit / Cost Sharing
The Affordable Care Act (ACA) provides financial assistance to low and moderate income individuals to help pay insurance premiums and provide cost sharing expense assistance.
The amount of premium help each individual or family receives is based on the price of the Silver plan. This means that the plan will cover 70% of the average costs, with the enrollee paying on average 30%.
the individual purchases a Gold or Platinum plan, they will pay the difference between the premium credit amount and the cost of the more expensive plan.
Determine If You Qualify For Premium Tax Credit
Cost Sharing Reductions
In addition to the premium subsidy, individuals under 250% of the federal poverty line are also eligible for cost sharing credits. This helps defray copayments, coinsurance and deductible expenses.
In order to qualify for cost sharing credits, the individual must enroll in a Silver or higher benefit plan. Eligibility for cost sharing means that the enrollee would not have to pay the full 30% cost sharing for the Silver plan.
In effect, they will be enrolled in a plan with a higher benefit value. For example, a low income family (below 150% of poverty line) would be eligible for cost sharing credits that would provide them coverage with an actuarial value of 94 percent. For a family between 150-200% of poverty level, the actuarial value of their plan would be about 87%.
Determine If You Qualify For Cost Sharing Reductions
|Members In Household||Household Income|
|1||$28,725 or less|
|2||$38,525 or less|
|3||$48,825 or less|
|4||$58,825 or less|
|5||$68,925 or less|
|6||$78,975 or less|