Obamacare News Blog

CA: Lower Income Persons Only Have 2 Exchange Options

The Affordable Care Act has touted the 4 types of plans it is offering, however on a health plan reconnaissance mission of Covered California’s website those with a low income only have the choice of the Bronze plan or the Enhanced Silver Plan. Just because there are less options doesn’t mean it’s a bad thing as well as you’ll probably pay less when you seek medical care. Let us explain.


Less Choices for CA Low-Income Residents

The new Affordable Care Act metal plans: Bronze, Silver, Gold, or Platinum are available in all markets beginning January 1, 2013 (however remember the sign-up begins October 1, 2013). We haven’t found it written anywhere if you of low-income and seeking a subsidy that Gold and Silver plans would be unavailable, yet on CoveredCa’s individual and family rate page the only options for those with a lower income ($22,980 or less per year) are limited to the Bronze and Enhanced Silver Plan.

1) Bronze Health Plan

The Bronze plan generally has the lowest premium of all plans, however it can cost quite a bit more if you seek medical care. Bronze plan details for those who make $22,980 with premium subsidies are:

  • Deductible: $5,000
  • Out-of-Pocket Max: $6,350
  • Premium: As low as $63 a month

2) Enhanced Silver Health Plan

The Enhanced Silver plan is only one that includes cost-sharing subsidies for help with deductibles, coinsurance and copays. With subsidies this plan can go from the traditional coverage of 70% to 94%. This is the reason lower income people don’t have the option on the Exchange of a Gold plan or Platinum plan, due to the possibility that Silver’s out-of-pocket costs could be less for those who qualify and have a significantly lower premium.

Enhanced Silver plan details for those who make $22,980 with premium and cost-sharing subsidies are:

  • Deductible: $500
  • Out-of-Pocket Max: $2,250
  • Premium: As low as $105 a month

Which Plan Should I Choose?

Up to what you can afford, but if you can spend $40 more a month the Silver plan is a much better deal.

Do I Have to Buy Insurance?

Almost all Americans are mandated to have insurance as of January 1, 2014. So, more than likely yes. There are, of course, exemptions to the ACA mandate. When you purchase if you think you qualify for subsidies you’ll probably want to purchase a Health Insurance Marketplace plan. However, if you know you don’t qualify you have the option to purchase either on or off-Exchange plans. Remember there are plans outside of the exchange that may work better for you. Your newly established state’s call center’s navigators or insurance agent can help you figure out which plan is right for you.

For further questions call 800-930-7956 or contact Medicoverage.

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