Everything in the Affordable Care Act (including the name itself) would lead us all to believe that health insurance would be affordable. The reality is that whether health insurance is now “affordable” depends upon a few variables – with household income being No. 1.

The Affordable Care Act mandates that all fully-insured individual and small group health insurance plans not only be guaranteed issue, but must also be “community rated.” This simply means that rates can only be based upon the following criteria.

  • Zip code
    • Where an individual resides
    • Where an employer’s corporate office is located
  • Age of individual(s) to be insured
  • Enrollment status
    • Single
    • Family
  • Tobacco use status of individual(s) to be insured

What does household income have to do with any of that?

Individuals and families whose household income is between 100-400% of the Federal Poverty Level (FPL) could be eligible for help in paying for health insurance premiums in the form of Advanced Premium Tax Credits (APTC). As an example, a family of four with a 2014 household income between $23,850 and $95,400 would qualify for help. The exact amount will vary depending upon the community rating criteria mentioned above, as well as the affordability of any available employer-sponsored group health plan.

If you are eligible for an employer-sponsored group plan, and the cost for single coverage (does not include spouse or dependent child premium) does not exceed 9.5% of your household income – you and your family will not qualify for the APTC. Even if your household income is otherwise between 100-400% of FPL.

For a detailed quote, contact one our CMS Certified agents today!