Obamacare: What does it cost?

[Update 11/19/12: If your household is more than just a single person, the figures below need to be adjusted for your family size!]

[Update 11/22/12: I came up with a graph showing the estimated cost of an Exchange policy for single people with "adjusted gross income" (AGI) between 133% and 400% of the federal poverty level. This is a range from about $15,700 AGI to $47,000 AGI, in 2014. No one knows what the official numbers will be in 2014, but they will be based off AGI in 2012. There is a planning opportunity, then, to make your AGI under 400% of poverty level this year if you feel you will need to be in the Exchange (example: if you have an expensive individual policy right now.)

Back to the original post: ]

I have been running the numbers from a spreadsheet I made in 2010.

As it stands now, in states that adopt the “Medicaid Expansion”, people who have adjusted gross income (AGI) at [or below] 133% of the poverty level ($14,000 or so for a single individual) would be automatically picked up by the state’s Medicaid. (You might have to fill out the paperwork.)

The Supreme Court decision yesterday made this Medicaid Expansion voluntary, so if your state is dumb enough to say “no” to the feds, you wouldn’t get that coverage. To give away a 100% federal credit to cover the Expansion for the first several years, a state has got to really be run by some people who can’t do math. But maybe there are states like that, south of me . . . (And maybe the very one I’m sitting in, when you think about it.)

Obamacare also has a system of insurance exchanges. These are for people at 133% of poverty level, all the way up to 400%. For a single person, that’s an AGI of around $45,000. For a family of four, maybe $90,000.

Starting in January 2014, there will be an exchange in each state where you can buy a policy and receive a subsidy from the government — just like how people who get employer-paid insurance don’t have to pay taxes on theirs. (That is a subsidy, too, right?)

For a single individual, here are some maximum prices I estimated:

AGI of $20,000: $1,067 a year

$25,000: $1,783 a year

$30,000: $2,577 a year

$35,000: $3,325 a year

$40,000: $3,800 a year

As you can see, the more income you have, the higher the price. But the price is still pretty reasonable compared to trying to buy an individual policy on the private market. (It’s expected that that old business will dry up under the new program, because you’d just go to an exchange and get the policy there. That is one reason why the insurance companies have had their cronies screaming about Obamacare.)

Remember, that that AGI is after deductions for things like 401(k) and IRA. Many people will discover that it’s better to manage their income in a way that brings them to the 400% of poverty level cap. This way, they would be able to get the exchange subsidy.

A lot of the people who have been screaming about Obamacare don’t seem to realize that a low priced policy would be a great benefit to them. They are afraid of being dropped by the employer’s coverage, and “forced” into the exchanges. Except the law says the employer can’t do that. Plus, this thing about “forced”. Again. The insurance companies in the exchanges will be the same ones writing employer-based policies. So you are getting the same coverage from a different delivery channel. And that’s really only if you lose your job and your employer-based coverage.

In Japan, there is employer-based coverage. Occasionally, and frequently with foreigners, the employer tries to skirt the coverage. In any event, there is always municipal health insurance. The premiums are based on the Japanese version of adjusted gross income. (It’s like our own, because the Japanese tax system was set up after the war by a Columbia Professor, Carl Schoup. But it has its differences. I digress.) You pay less if you make less; more if you make more. There is a cap of about 690,000 yen, I think. At least, that’s what it was in the last full year I was there.

If you ever lived under another health system, you know how screwy the American one is. Obamacare starts to fix it. It’s not a complete fix. It’s like a jerry-rig of a fix on to another part they don’t want to change. But it is a fix.

It’s better than what was, for sure.

[Update: It isn't clear whether, in states that don't adopt Medicaid Expansion, whether their people under 133% of poverty level can go to the exchange and get the subsidy there. At $14,800, an exchange policy is $297. Why can't they just offer that price for people below $14,800?]

[Update 6/30/12: The 2012 U.S. federal poverty guidelines. 400% of poverty level for a family of four is $92,200.]

[Update #2 6/30/12: What is "household income" for purposes of the Affordable Care Act? I've seen a couple of different Powerpoints online that attempt to say, but I am going to rely on IRC 36B(d) as linked. It sounds like it's AGI off the tax return, plus the Foreign Earned Income Exclusion, plus any tax-exempt interest. I don't know if they ever fixed that loophole where the seniors who retire at 62 can collect social security and have it not count as income if it's off the tax return.]

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184 thoughts on “Obamacare: What does it cost?

  1. $40,000: $3,800 a year which is $316.66 dollars a month. for healthcare. A friend of mine showed me this, he currently pays $180.00 dollars a month for single healthcare.and makes $42,000 a year. So what your saying here is he will have to pay more for healthcare under Obama care. Because the company he works for can offer an exchange and pay out less. then the healthcare they offer now which they pay more for. so it figures it actually saves businesses money but the worker higher cost for health insurance.

    • The company cannot dump their plan and go to an exchange.

      If your friend is paying $1,800, it means that $1,800 is the competitive market price in your state. Therefore, it is highly unlikely that his insurance company could boost that to $3,600 without another company going in and picking up your friend’s business for much less. What the new plan does is guarantee that if your friend ever loses his coverage, he can pick up new coverage regardless.

      • Incorrect! The company can drop the coverage, but they have to pay a penalty. In many cases the company will still come out ahead by dropping coverage.

        • What I said is that the company cannot drop coverage AND go to the exchange. The employee can always go to the exchange if he/she is not covered. I read that the fine is big enough that companies would not drop coverage just to try and save money on it.

    • the problem is that if he is a single father with children, he will cost the company about 5,000 a year more in premiums or they will have to pay 2,000 in fines per year. single folks are going to be desirable hires.

      • No, that’s not true. Premiums are age-assessed, with children costing much less than the parents. So it’s not $5,000 and $2,000. That’s just scare tactics. People are added their adult children (under age 27 years) onto their policies for less than $1,000 a year, right now, due to early rule Obamacare changes.

    • Hi, I am 61 ,male ,and pay 900.00$ a month on healthcare, I am in good physical shape , Obama care seems like a very good change to me, [I make 40k a year]

  2. HUH companies can drop health care, and pay the fine which is cheaper to pay for the individual, and you will be forced to buy what Ocommie care tells you you can afford dont like it cant afford it oh well the government tells you that now wether you like it or not, its called going to single payer, Obama said this in his own words to Union members, how do you like and hate those apples, Commies rule !!!!!!!!!!

    • Huh nothing. If the companies drop and pay the hefty fine, the employees can go directly to the Exchange. They can choose to buy a policy there—from the same insurance company that the employer was dealing with. (There is no Public Option, which many people here had wanted.) The insurance company cannot price gouge, because they must pay out 85% of the premium as benefit. Otherwise they have to refund the premium difference to the insured.

      The health insurance inside the Exchange is subsidized—but so is (tax-free) employer-provided insurance! Both have a subsidy from the government! So there’s no difference, except that people are now no longer naked and SOL if they lose their employer coverage.

  3. The price you list for a single person making 40k Is $3800 a year and the tax would be about 1/3 of that. So you for those young people who dont need the full coverage they still save by not being fully insured only now they get 3% of their income extorted to pay for the ever expanding entitlement people now covering over 50% of the US population.

    • Well, no, that’s just wrong. $3,800 is the maximum that they could be charged on a policy in the Silver tier. If they think they’ll never need health insurance, they can buy a Bronze policy (60-40 coverage with major med) and apply the premium credit to that policy.

      If the health care costs are low in that state, it may mean they are out of pocket 1% on premiums—maybe even nothing after the credit.

  4. I have a question…what if the husband/wife do not work voluntarily because their mortgage is paid and they have enough in the bank to live off of? Would they be considered low income even though they aren’t low net worth? Would they qualify for “free” coverage?

    • That’s right — no more Medicaid asset test. So they could be a 60-year-old couple, with $600,000 cash in the bank, and making $1,500 in interest a year. They get so-called “free” coverage while they burn down their assets (unless they live off the $1,500).

      Ironically, when the couple turns 65, they get Medicare, and no one will make snarky remarks about their assets.

  5. I got some quotes for a single person with pre-existing/age group. The lowest quote was $550 a month with a $5,000 deductible and only pays 60% over that. If the cap for me is $277 a month with the deductible being at $5,000, I essentially cannot use the ‘insurance’ can I? So I have to pay the useless insurance AND pay for my doctor visits out of pocket, which I currently do. Wow, what a deal.

    • This obviously has nothing to do with Obamacare, since it is not fully effective until January 2014. What it sounds like you are talking about is a private plan that is NOT coming from the 2014 state exchange in Arizona.

      • And if there is no exchange set up by Arizona. They are under no obligation to do so. ACA has not provided funding for the federal govt to set up an exchange, and it is unlikely the GOP isn’t going to allow it to pass. Obamacare relies on state cooperation and if the states don’t as in medicaid expansion? Obamacare will flounder and the individual is stuck with huge new expenses/taxes and little benefit from insurance.

        • If Arizona does not set up an exchange, the federal government is REQUIRED to do it for them. If Arizona does not do a medicaid expansion, it’s your loss as a state. The taxes to support the expansion (from those making over $250,000) will still be collected; the money will just be spent elsewhere. As you know, the first three years of the expansion are paid by the feds, then at a rate afterwards of 95%. Arizona blew off Medicaid until 1981—it was all money lost that the Arizona hospitals had to collect by overcharging the people who did have insurance.

          • The federal govt may be required, but if they dont have the funds approved, it won’t happen. Whether it is our loss or not, obamacare is just a disaster waiting to happen and us little people will pay for it, not the rich. Thanks for nothing…..

            • A judge can compel the administration to implement the law. You keep skipping over the point, that if your state does not implement a health insurance exchange, you will get the federal exchange. The federal exchange is only made once, and then the states that didn’t follow the law are automatically put into it. Time for Arizona cry babies to grow up. If you don’t like America, give yourselves back to Mexico where the land came from.

            • no a judge cannot compel taxes, that is the sole constitutional role of congress, not the judiciary. So we won’t get an insurance exchange. No crybabies, that’s unprofessional of you. It is time for you socialists to find a country that has socialism or time for the states to go our separate ways. I am for that. You can live in your ‘worker’s paradise’ and totalitarian govt, the rest of us will go back to what the founding father’s designed.

            • Well, I think you need to tape your comments to a wall, and see how much of it won’t happen. Judges can rule if taxes are constitutional; the federal government will set up exchanges. Good luck next time.

  6. What happens if your income comes from rentals say 35,000 family of 4 and you have 500,000 worth of equity on a million dollar worth of properties. Do i still qualify for Obamacare?

    • There is no asset test. There is no asset test for Medicare, either, is there? Is there an asset test to get the employer-paid exemption on health care for people who get the health insurance from their company? Good luck trying to convince people that they have to spend down to bankruptcy before they can get a subsidized insurance policy. I see you people a mile away.

  7. sorry buddy commies @ 25,000 a year 1,300, to 1,500 dollars out of pocket is too much for me to afford right now already live life at my means, no cable, no fine dining just live life already as minimal as i can, NOW pay a fine to help others get healthcare while i starve and dont hace health care myself, NO then prove me wrong god already live cheap as i can, low bills low rent i cannot as a poor actually working person afford this liberal untied states, i actually work for the love of god and communism is killing me and taking food from my table i will NOT get health insurance and WILL NOT be paying the fine, prison or death either way, the people will rise and take this country back are die trying i promise!

    • In other words, you still have the emergency room door open to you, and you have an honor promise of having to pay a “tax” of $95 to get that. The grapes are sour this morning, (again like 2008), it seems.

      • So I live in Nebraska I’m a single mom with 3 kids. My kids qualify for Medicaid and receive it because of my income. Right now my insurance through my employer is free to me. Will my kids still be able to get Medicaid with this new health care reform act? My family insurance at my work is $400 a month right now and I definitely can’t afford that.

        • You are set. You get federal tax credits to cover yourself. Your children get to stay in CHIP, unless your governor starts screwing with that out of spite for being a sore loser against Obama. If they cut back on CHIP, your kids will go on your employer policy for the same price as what you are covered for (i.e. net zero cost).

  8. Thank you for your in depth study and HW. I’m curious, as a NYC teacher, I’m pretty sure that my GHI- Emblem health plan is a Cadillac plan with Corinthian leather. So after let’s say after 18 years I resign or gloomy finds a way to get rid of me. Will GHI allow me to stay? Is it even worth it with the exchange? I’m fortunate to have a revenue steam of 60 k from investments and real estate. So, with a lower AGI, married no children, where do you think my wife and I stand out of pocket?

    • I don’t know how collective bargaining works for New York teachers, but generally, on retirement, you get continued coverage, right? Usually at some reduced, out-of-pocket cost, if not fully subsidized by the school district. My sense is that if your AGI is within that 400% of poverty level range (which is actually a HUGE range that covers most middle class people), then you could continue on GHI with some premium credits as well. If it’s a Cadillic plan, you know, it’s the insurer that bears the surtax. What happens in 2018 is way out enough that no one can make good calculations. My guess is that the plans will all work to keep their cost below the Cadillac surtax floor.

  9. I’m a single mother of 2 making around $32000 a year. My kids are on their dads insurance. I forgo insurance because my work offers incentive of more pay in exchange for no insurance. How will Obamacare affect me?

    • If your kids are claimed on your tax return, you are going to get a large premium credit for you to pick up your employer’s insurance. There is some chance that your net out-of-pocket will be zero. (You pay to be in, and the feds offer a credit to cover the cost.)

  10. First of all thanks for making the blog makes me understand more the Obama care. My question is the following will this be based on income you basically make? Say you own assets (rental income) and you make per year $30,000 gross and after deduction your left with $20,000 that will apply obviously on income tax. Now will there be a problem for the rental incomes you own? Reason I say is of what I heard when you get medicare if you own land and apply for medicare the government will take your home when deceased. I am just curious if its all based on income (I saw you answer an example someone having half a million dollars yet the $1,500 would be all that would be put into account). So assets will not disqualify you to get the Obamacare or make it an issue only how much you make per year?

    • That’s right. There is no asset test for Obamacare (the Affordable Care Act). There is, also, no asset test for Medicare (health insurance for seniors or the aged). There is a test, however, for people on MedicAID. Medicaid was only available to people without (that is, in or near poverty). The Medicaid rules will change in 2014 in states that adopt the “Medicaid expansion” part of Obamacare.

      • Thanks for the reply. Shifting to medicare isnt there an asset test (say you get medicare) where the government can take your homes after you go deceased? For medicaid we wont qualify since we make to much according to the government. So Obamacare is all based on the income you make? So by how you say Medicaid expansion that means it will be easier for people that make some income qualify for it? For example I am going to be independent next year I have 2 part time jobs and I believe I will make at the moment $12,000 an year. Will I qualify for medicaid (single man no kids will)? I one time I applied for medicaid (or something similar) to get my teeth check was making little income. I remember when applying they wanted to see my bank statements. Will savings in the bank affect it to get into medicaid or the expansion of medicaid set new standards of who can get it and how cant? Once gain really appreciate your reply and education myself more (like never heard of asset test).

        • In states that expand Medicaid, there will be a new formula to determine eligibility. It will be simplified, and it will be based off income. No asset test.

          It is not clear what happens in states that do NOT expand Medicaid. This was an issue the Supreme Court left open. Contact your state representatives and governor and tell them you want Medicaid expansion.

  11. We would all like to be insured at a low cost, but I’m concerned about the long term results of moving health care out of the private sector and making it a government entitlement. How will we pay for it over the long hall? The answer is simple, generate more government revenue by either increasing taxes (which is likely) or generate growth in the economy (which increases tax revenue by making the pie bigger). None of us want to pay more taxes so, how does one increase the revenue pie if we take a huge chunk of money from the private sector? I think Social Security and Medicare are excellent examples of what happens when the government runs social programs – down the road we run out of money.

    Why not try some private sector ideas like allowing people to purchase health insurance from insurance companies in any state? This will open up competition, which can’t hurt. I have also noticed a lower cost use of RVN’s for family medicine issues. For example, I personally use an RVN when I have a cold or flu – She runs a very nice clinic and charges $55 per visit. Why not move in this direction?

    Yes, free medical insurance sounds great but we all know the old saying, “nothing is free”.

    • The Affordable Care Act keeps the private sector in the medical insurance industry. It simply regulates them like a utility. This is long overdue.

      There is no “free”, except the extremely indigent. The emergency room was an unacceptable method of treating poor patients, and so now, in states with Medicaid expansion, there will be publicly paid care. I see no problem with this. These are people who have nothing, or relatively little. At least they will be able to keep their health. All other modern countries do it this way.

      For the general public, Obamacare, its nickname, sets up a health insurance on a sliding fee schedule. Up to 400% of the federal poverty level, there are premium credits available starting in 2014. What is the difference between premium credits, and the current (and continuing) policy of providing TAX FREE employer-paid health insurance? Tax free health insurance means that the person is not paying tax on that income. It is no different than the government handing a credit, at that person’s marginal tax rate, to help pay for insurance. Mathematically, there is no difference. The only difference otherwise is that the assistance is prorated for how much income the middle class resident has. Lower income, more premium credit.

      Pre-existing conditions get covered. People are, or should be, in an insurance program, so pre-existings should be no issue anyway.

      You mention cost. All the countries that have universal coverage already, have lower costs than us. How? Well, because they’re being taken care of all along the way. Metabolic disease (diabetes, heart disease, high blood pressure, etc.) is addressed and treated sooner, so costs don’t escalate. Metabolic diseases are 75% of global health care costs, weighted more heavily to America.

      Obviously, as you say, if costs continue out of hand, we will have to tax or regulate the foods in our diet that make us so sick. The evidence is pointing to sugar. I would favor a sugar tax if it turns out that health care costs are not brought under control.

  12. I think this topic is very important, and thank you so much for clearing some of my question. Although I know there will be many more as we begin to enter into this Obamacare phase.im not comfortable with Obamacare but I felt it was the best choice rather than the Romney plan what little we heard, didn’t not like his ideas so that’s why president Obama got my vote. However, my question is why do they call it a tax on the middle class when it was said that it wasn’t a tax. Is it because we are now going to have to pay a premium? What part of it is going to be a tax? Right now my job gives me 500.00 a month for insurance will Obamacare affect this?

    • It is not really a tax on the middle class the way income tax is. It is like a tax, though, because there will be a requirement that people obtain health insurance or pay a “shared responsibility fee”. It was this fee that the Supreme Court said was the equivalent of a tax (and so therefore Congress was well within its “taxing power” from the Constitution when they passed Obamacare).

      If you have employer-based insurance, nothing changes. Whatever your share of the payment is, you might be able to get premium credits (tax credits) to offset some of the cost. If you ever lose your job, a health insurance exchange in your state will provide you with the ability to continue to have health care coverage. Premium credits are also available on those exchanges.

      The controversial part is that people who don’t understand the premium credits think that this is an unusual, big giveaway of money. But the government has been giving money towards certain people’s health insurance (those who get it from their employer) for so many years now—since back to the World War Two era. All that changes is that more people can get help from the government, and they cannot be turned down for a policy. Both are good things.

  13. Lets say you are a factory worker and have insurance through your employer. And say your employer pays a portion of your insurance. If the employer drops coverage, takes the penalty instead, you, under the mandate, are required to maintain a policy or be taxed (penalized). Now, say you go over to the exchange. And say you are making a modest amount of money ($32,000) with a family of four. Say the annual cost of insurance under the exchange is $13,500. The subsidy is $10,742.00. Your monthly premiums such that the subsidy is $6000 per year. Say your premiums are now $1100.00. Granted, the government will subsidize the majority of that premium. However, am I incorrect in assuming that the subsidy will come after you file your tax return. So in other words, the person through their employer was paying maybe half the premium, but under the exchange, you would pay the full amount, an amount that is not affordable because you have to wait for the subsidy a whole year later. Am I missing something? I have not seen anyone discuss this practical issue.

    • You can direct that the subsidy go directly to the insurer, in which case, the insurer will collect the receivable, rather than you wait for it. By the way, it is highly unlikely that employers will start dropping coverage. But what is the case now? Employers often drop or push the cost onto the worker. If you can’t pay, you’re screwed. At least in 2014, if something happens with the coverage, there is the Exchange and there are the premium credits.

      • I have just found information that “some” will qualify for an advanced credit, so that does answer my question. Your contention that employers are unlikely to drop coverage is yet unknown. There are several different types of employers who are faced with this decision. The first is the one like myself who employs ten people. We provide 100% payment of insurance for employees and their families. I will drop the insurance and encourage the workers to go on the exchange or medicaid if they qualify. That will be a certainty. The second type of employer is the one who already provides insurance and is under the mandate to do so. They will have to calculate whether the penalty costs more than the insurance and then offset with whether dropping insurance is going to greatly impact their ability to draw workers. By my rough calculations, for a local factory it seemed that they would save a lot more by taking the penalties. Plus, even if they provide insurance and one person opts out and gets a subsidy on the exchanged they are penalized regardless. Are they penalized for each employee after the first 30 or just for each employee that gets on the exchange. I would assume it is the latter.

        • Well, it would make sense that some would not get the advanced credit, because they get it another way. Why? If you have a high income, and know that you will obtain the credit, you just adjust your federal tax withholding to ratchet down to the difference. Use that money in place of the credit, and then even it all out in April 2015.

          If an employer drops, then what happens? Yes, there’s a penalty. And yes, the workers get to go to the Exchange. The employer is still worse off for having dropped, because they’re stuck with the penalty. The workers can go to the Exchange and get the same coverage, probably for less money than the same insurer would charge the employer. (The insurance companies writing policies on the Exchange will be the same ones selling insurance on the group markets. In most states, two or three insurance companies have the bulk of all the health insurance business. So it’s not like the Exchange is some dark closet off unknown underwriters. This point amazes me, that people trust two or three huge businesses in place of state government, when state government could do the same thing for less money.)

          I am sure that some employers are going to work the math, and conclude the one thing, as you say. And it might work for one year. But, at some point, the penalty catches up with them.

          • We can talk about trust later but I have a question for you. What happens in the scenario where the employer does provide insurance, but for whatever reason an employee goes on to the exchange AND takes a subsidy. How is the employer penalized in that situation? I simply am not clear on the answer.

  14. I’m self employed and gross income is about $95000, AGI is $50000 so I would like to know how much it would cost me for family of four. Thanks Slaven

    • My guess is about $3,250 for an exchange policy, after the federal credit. $50,000 is a little over 200% of the poverty level for a family of four.

      There is also “cost sharing”, meaning that the feds will upgrade what you have to pay as co-payments on the policy. (You pay less if you use the policy.) I don’t discuss that above.

  15. My wife will be retireing at 62, I am already retired and over 65. My question is how much will it cost my wife for health insurance at 62 as she is considering working to 65 solely for medical benefits? Our income including social security is 75,000.

    • The question is, what is your adjusted gross income? As you can find out here, 400% of the poverty level for a family of two is just over $60,000. Regardless of where your income lies, though, you still get guaranteed issue on the Exchange, if the employer does not offer coverage.

      • I have read that no premium credits will be given if one of the spouses is getting medicare. Also married filing jointly is required. Therefore the entire cost will be on the insured with no credit which becomes very very expensive. Is this wrong I hope?

          • Thanks for the response. Following is what I read and hopefully this is not true as it claims if any member of family is covered by Medicare part A then premium assistance will not be allowed:

            Minimum Essential Coverage
            A taxpayer is allowed a premium assistance tax credit only for any month that one or more members of the applicable taxpayer’s family —
            i. Is enrolled in one or more qualified health plans through an exchange; and
            ii. Is not eligible for minimum essential coverage other than coverage in the individual market.
            “Minimum essential coverage” means and includes —
            • A government-sponsored program, including coverage under Medicare Part A, Medicaid, the Children’s Health Insurance Program, and TRICARE;
            • An eligible employer-sponsored plan;
            • A health plan offered in the individual market;
            • A grandfathered group health plan; or

            • Yes, the language is right, but you’re reading it wrong. The test goes to each individual. So a spouse on Medicare is not eligible for premium credits. But the other spouse would be entitled to premium credits if they [he or she] are covered in a Health Insurance Exchange plan.

            • If one spouse is >65 and thus on medicare and the other is<65 can they file as married filing separately if the younger spouse has almost no income to get insurance on that spouse on an exchange at a much lower cost?

            • Generally, no. Married filing separately bumps you out of the premium credit statute, because it would be a way for people to obtain a huge credit for the nonworking or very low income spouse.

              After all, in the one-spouse-on-Medicare situation, there is already a subsidy going to the Medicare recipient. Most Medicare enrollees (Part B enrollees) pay $105 a month. But the actual cost of coverage is something over $400 a month. So right there is a significant “credit” of over $3,600 a year.

              Plus the Medicare Part A is at no-cost if the enrollee has 40 credits in Social Security . . .

            • It looks to me that if a couple makes $50000 a year and one is on medicare >65 and the other is enrolled in an exchange <65 they will pay almost $12000 a year between the two for health care premiums…sounds a bit excessive don't you think?? Or do I have this wrong? Also for a family of 4 that makes just over the 400% will pay 3 times what a family of 4 at 400% will does not sound like a fair or a well thought out plan. Thoughts?? I guess people will be asking for pay cuts and divorces more as a result of this "plan"??

            • No. It sounds like the couple making $55,000 (MAGI) will pay 9.5% of that for a Health Exchange policy, net of the Premium Credit. So $5225 max for the one. The other on Medicare would normally pay the $104.90 a month, which, as I said elsewhere, is a heavily subsidized rate. (That is: “you didn’t build that. Somebody else [helps] to make that happen.”)

  16. I’m a single mom with one child. I get no child support, my adjusted gross is 34k a year but I’m still living paycheck to paycheck, my employer pays for my insurance but it would be $400 a month to add my son and I make too much for my son to qualify for CHIP anymore, am I really going to be paying almost $300 a month for him????

    • No, it would be nothing like that. Under estimated guidelines, the worst you’d ever end up paying (combined) is $200 a month. That’s like if your employer stopped covering you, etc.—a situation like that. Plus, you’d get shared cost credits, so your out-of-pocket if you used the insurance would be very low.

      Chances are, the insurance company will be required, under new rules, to offer the coverage for your son at competitive rates (not $400 a month). There are people who are getting their children covered under this “up to age 27″ transition rule for $70 a month, which is cheap.

      • By the way, do you know, that there is something new in the regulations. It’s the “CMS Proposed Standard Age Curve”—which is the Obama Administration’s guide for how much an insurance company will be able to charge based on age? A child’s coverage will cost no more than 63.5% of what it costs a 24 year old for coverage. So if you’re being told, “$400!”, that’s going to be nonsense soon—if it isn’t already.

      • You say her out of pocket will be “very low.” You just skipped.over the part that she is living paycheck to paycheck. This a perfect example of someone that won’t be able to afford coverage and will have the IRS deduct it from her tax return. She will have to pay the penalty and still won’t have the insurance. Quit being a mouthpiece and tell these people the truth instead of your idealistic scenarios.

        • The IRS will not deduct it from her paycheck. That was the whole point of the “shared responsibility payment”. It was ruled a tax, but with no enforcement mechanism (unless you are due a refund!)

          I am assuming that commenters here aren’t trolls, but there was one wild assumption in the story: that the child would cost an extra $400. That means her own coverages were at least $600, paid all by the employer. That just doesn’t jive. (How do I know, by the way? Because premiums will now be age-assessed. A child is always going to cost less, and often much less, than a parent.

          So the facts remain, that if there is any increase, it will be very small. And, in return, the worker gets this vast benefit. The deal would tend to be something you take as a gift horse, and see what other spending you have that’s the thing you really could do without. Not health insurance.

  17. so…if im doing all this right, for a family of 4, our AGI from this past year was 37000, the year before ( before i lost my job) was 61000. going off this past year we shouldnt pay more than $2100 a year? and based on my numbers from the year before (since i just got a new job) it would be???? still the same since we dont crack that 400% / or $110k a year correct?

    also, a big thank you from all the families that your helping plan out going forward.
    my hats off to you sir.

    • If you have AGI of $37000 for this year (2012), I am estimating $1650 for a policy. (This is your maximum cost, net of the federal credit. If you have a job with employer-paid insurance, then this is obviously moot.)

      There is also cost-sharing in that income band (150-200% of FPL).

      The health care credits available in 2014 will depend on the AGI for 2012. This is, in part, because enrollment is going to happen in Fall 2013 (next fall). So the only information the government will have available would come from the 2012 tax filing. Medicare has a lag like that, too.

      If your income goes up year-over-year, the federal credit would be adjusted down. I’m not sure if the federal credit for 2014 is impacted by whatever happens with AGI for 2013, but 2015′s definitely would.

  18. I am self employed with 61 years old with and average income of around $ 40,000. Currently I am paying around $ 6000.00 from Blue Cross. Is the new plan going to save my money?

    • Yes. It will cost no more than 9.5% of your adjusted gross income. If you are single, this means 40,000 times 9.5% = $3,800. Additionally, there are cost-sharing credits if you use the insurance.

  19. can you talk more about these ‘cost-sharing credits’ that you keep mentioning? even if all you can do is elaborate on the idea and not provide numbers…thanks…

    • Well, maybe I can do better than that with this link: http://www.cbpp.org/cms/index.cfm?fa=view&id=3190

      What is going on here is that people who are at less than 250% of federal poverty level are going to be given additional tax credits to cover part of the co-payment that their insurance requires. So if someone has the “silver plan”, which is 70-30 coverage (person pays 30%), they will be given additional credits if they are using the insurance and paying the 30%. The idea is to make the insurance affordable to use, not just affordable to have.

      • I’m on Medicare. My spouse is younger than age 65. We live in a community property state. Is the eligibility for a premium credit for my wife determined on 100% of our adjusted income or 50%?

  20. My wife and I both retired early and have a high deductible individual plan. We will be moving to one of the plans in the government exchanges in 2014. This year a I received a small inheritance from an IRA an Aunt left me. The amount was taxable and will be calculated as part of my AGI. This was a one time gift that will give an inaccurate account of my usual income in a year which is very meager. Is there any way I can have this amount adjusted for the purpose of receiving more in the form of tax credits to help me pay for my insurance? Even with the small inheritance I will still fall below the 400% threshold, but it will likely effect my subsidy by hundreds if not thousands of dollars.

  21. My brother in law and I have already paid the taxes on it, they were taken out before my portion was even sent to me. The IRA was divided among several people.

    • That’s a shame. Had you been named as a beneficiary in the IRA itself, you could have done a “trustee-to-trustee” transfer to an IRA separate from your brother-in-law, and just kept it as tax-deferred, taking RMD only. This would have avoided the income situation. The only other way I could see you reducing income is if you had earned income during the year (this year-either you or your wife), you could possibly make an IRA contribution of your own. Otherwise, the IRA distribution in 2012 affects the premium credit for 2014, even though it was, as you say, a one-time event.

      It may be possible, and I don’t know, that if 2013 turns out to be lower, you can somehow benefit from that in 2014. (For example, a sudden change in income down might affect what people can pay for an exchange policy.) But I have the strong feeling you have to wait until 2015 for it to affect premium credits. I would have to research the matter more.

  22. I think I was named as a beneficiary in the IRA and I was given a number of choices of how to receive the money, but transferring it into another IRA was not one of the choices. I think it seems a little unfair and I may call them once they start sending out the info on these plans, there may be some way that it can be adjusted. I am certain there will be others affected by this scenario! Thanks so much for your blog and your quick response!

    • Yes, it’s too late. The IRS will say it’s a distribution. People should always name beneficiaries on their IRAs, and the beneficiary should always take in a “trustee to trustee” transfer. If the IRA pays to estate as beneficiary, that’s no good. If the beneficiary turns around and takes a check in their name, thinking it’s a “rollover’, that’s no good either.

      If you or your wife had “earned income” this year (income from work), you could possibly do an IRA of your own, up to the max ($5,000 or $6,000 max for each.)

  23. OK, that is what I thought. A couple of last questions if you don’t mind. 1) Since we will get less tax credits in 2014 because of this IRA distribution, couldn’t we just get a lower cost plan (bronze) and then in 2015 when we will have more credits move up to a better plan, or will moving from plan to plan be more restrictive than that?

    2) If we chose not to get insurance in 2014 and pay the “tax” if we got sick during the year or had a heart attack, how long would it take for us to get insured? Would there be waiting periods, processing time, etc.

    Thanks!

    • Well, if you think you would need a health insurance policy in 2014, I wouldn’t go bare until the time you realize you need the policy. I would sign up in Fall 2013 like everyone else. (At least, everyone else who knows better!)

      About “metal levels”: if you have a HDHP now, then the Bronze Plan (60-40) might be the best choice. I know that the Exchanges only have to have a Silver (70-30) and a Gold (80-20), at minimum.

      The federal credits are based on the second lowest cost Silver Plan in an exchange. Also, keep in mind that there are cost-sharing credits, which are different than the one for the insurance itself. Cost-sharing credits go to assist in whatever co-pays are required. So a Bronze Plan co-payment (40%) may be subsidized down to a 30% by these credits—or more, on a sliding scale.

      What you hit on with the IRA distribution is, as I’ve said up in the main text, there is effectively a surtax, at marginal rates, for anyone eligible for federal credits. This is practically everyone who doesn’t have an employer-based plan.

  24. Pingback: Taking a rest from daily posting. | Hoofin

  25. Thanks again, but if we are able to go with a bronze plan to save money in 2014, would we have any trouble going to a better plan in 2015? Is there an open enrollment period each year that makes going to a better plan available and easy to do? If you can answer that I will leave you alone, sorry for all the questions but you seem very knowledgeable!

    • That’s the beauty of Obamacare, though. Once you have at least the Bronze Plan (60-40, with you as the 40%) Silver Plan, the cost-sharing federal credits raise anyone in certain “bands” (100% to 250% of federal poverty level) to be, net, in at least as good as better than a Silver Plan (70-30). UPDATE: You must be in the Silver Plan (at the minimum) to get the cost-sharing credits.

      I suppose you could switch in the future. (I’m not sure if it will be like open enrollment in Medicare C or D.) There is probably going to be a spreadsheet calculation needed, for whether it pays to pay it out as insurance premium, or wait until you actually have bills requiring a co-pay.

  26. Thanks for the update, that actually makes sense! People would be opting for the lower cost option in order to save money on their premiums, but then if they became ill or were injured they would have the funds necessary to cover their deductible. Better to get them into a more comprehensive plan from the beginning that will pay more of the costs for them.

    I am just going to have to pay more in 2014 because of that IRA inheritance, and then in 2015 I should get more credits as my AGI drops down to normal.

    • It’s unfortunate, but had you been told by the IRA trustee about the possibility to have your share put into a separate, inherited IRA account, then you wouldn’t have had the income leap all in 2012.

      It’s a point that I’m afraid was lost in all the b*tching and moaning by Republicans about Obamacare. What could have been going on in the meantime was telling people that their 2012 tax return is VERY important when it comes to the first year of this new program (2012), and for people to do the right tax planning. Your situation is one of the rarer ones, but how many people who are, say, right around the 400% of federal poverty level, know to try and make their adjusted gross income UNDER the 400%, if they can?

      I’m sure sites will start popping up with nice Java applets showing people what they need to do. But it will probably happen too late.

  27. It seems to me that you are missing a core point here. No matter how ‘good’ the price for the insurance may or may not turn out to be, it is the government forcing people to pay out MORE MONEY EVERY MONTH that they may not have. Just because some kooks in Washington sign a paper requiring folks to purchase insurance, their actions certainly do not increase the our income, and in fact decreases our incomes by the government stealing from us.

    • You’re right: my point is not your point. Your point ignores the fact that, when Congress passed the Affordable Care Act, it put enough subsidies into health care that it changed the relative prices between health care and everything else that people spend their income on.

      In effect, for the vast majority of Americans, health care will now be cheaper than it was before the act.

      No one is “forced” anything. You can always pay the shared responsibility payment and continue to go bare. It just makes a lot more sense, instead, to buy a policy and cut back on some other expense. (Soft drinks are probably the most obvious target. Cigarettes, etc.)

  28. THANK YOU SOoooo Much for sharing your knowlege about ACA
    you answered some ? my brain hadn’t thought of yet
    Yes, you’re right it wasn’t/not out there how important our 2012 taxes are for this ACA Thanks Again -Sunny

  29. Just wanted to add -As of right now Medicaid in Az. doesn’t have an asset test at least not for the childless adult but you can’t have over $5,000 in cash/checking/savings account

  30. Just want to see if i got this right or maybe it’s a ? really
    Single- under 60yrs- own your house – somewhere between $30k to $50k total combine accounts – pt self employed- AGI somewhere between $10k to $20k a year Will this person qualify for Medicaid or will they go with the new ACA in 2014- Thanks-

    • If the legislature does not do Medicaid Expansion in your state, you would have to be at about $11,800 MAGI (est. 100% of federal poverty level) to receive federal credits in the Health Insurance Exchange.

  31. (Am I right?)… From what I can gather, the Exchange will really only benefit the very poor, mostly poor, or those that “look” pretty poor on paper. Individuals/families (living in a major city like LA, CA, which generally equals higher costs for everything) making (barely) over 400% of FPL are pretty much screwed. I’m afraid we’ll be stuck in the private/individual market, continuing to struggle to keep up with the insanity of increasing premiums [interesting how they always seem to make their numbers fit the percentage of what needs to be spent on medical costs]. Got a whooping $8.26 Anthem refund on over $10,000 in premiums paid (for 1 adult and 2 kids) – and we are far from being on a “Cadillac plan.” Even Anthem says they consider 9.5% a reasonable sum to pay for healthcare (for what? a $14,000 OOP plan?). Such a joke. I was looking forward to Obamacare – but not so much after a buzillion googles. Seems it’s hardly worth it to try to better your situation by trying to make more money (to pay for college, retirement, a better rental to live in, etc…) because it will just shoot you over the 400% … which leaves us non-Medicare eligible limbo dancers stuck in a premium paying black hole… on or off the Exchange. Question for now is: go broker trying to stay on the plan I have right now — or switch and loose my “grandfathered” status? They are discontinuing my PPO plan (guessing because it has a lower OOP than most they are now trying to peddle), but they also are raising it to a brutal $1100 pr/mth to keep it. Still – some insurance blogs think that the Exchange rates could be 30-50% higher for comparable plans (mine currently has some Silver-ish characteristics, but likely a lower OOP). Without a crystal ball to predict future income and expenses, I feel stuck about what to do right now (have to decide by 1/31 to switch w/out underwriting). Sorry for the length, but you’ve been so kind to address everyone’s posts & no one seems to be addressing the “freelance/self-employed” who might sometimes/some years fall outside the shadow of the FPL.

    • I agree with you that, if you sit just north of 400% of the federal poverty level—with no way to bring your MAGI under the 400%—you are in a situation that sucks.

  32. If someone is on Medicaid in 2014 and then in 2015 makes too much money to be on Medicaid and gets kicks off Will they be able to buy an exchange policy or have to wait until filing taxes for 2015 ? Thx Sunny

    • Interesting question. I bet the kickoff happens on a delay, when MAGI makes the person not qualified for the (no charge) Medicaid. Presumably the Exchange kicks in.

      • So you don’t think you would be dropped off of Medicaid as soon as you made to much money
        But when would you be able to buy an exchange policy Do you have to wait until you file taxes that year ?
        Thx Again Sunny

  33. Yep, sucks… tough choice – 1. try to stay poor to access government “protections” within the (fairly high deductible/high OOPs) Exchange or 2. try to rise above being poor, but remain a premium slave in either market… fun times. I feel sorry for our kids. Thanks for the sympathy.

  34. Thanks. Is your firm in PA? One last question: What are your premium projections for the Bronze, Silver, Gold, and Platinum plans for singles and/or families – if over the 400% & paying out of pocket? Your graph was great, but I wasn’t sure which plan it involved.

    • Yes, it’s a Pennsylvania firm.

      If I had a good guess for the “Metal Levels” on the new health insurances, I’d be right in there with the insurance companies. It sounds like they themselves don’t know how they are going to price come October. My sense is they are going to base the Bronze on something close to their average quotes now (since the claim is that the overall pool of insured is only covered to 50% of actuarial value, not 60%, which is Bronze Level). Of course, individual policy rates will no longer be. So probably individual policies go down in price; group policies go up.

  35. I am a 50 year old, self employed, married man with a senior in high school. Right now I have in place a 5000.00 dollar deductable per family member (only 2 people in my family have to reach the deductable) with an out of pocket cost of 3000.00 per family member. I am paying about 5500.00 a year for this insurance.We chose not to get a prescription plan with this plan or maturnity care. It does cover wellness checks and all of the preventive testing at 100%. It also has no lifetime maximum dollar amount. It is a comprehensive plan. After the deductable the insurance pays 80%, I pay 20% up to 3000.00 then the insurance covers us at 100%. My concern is if i do not meet the 400% poverty level for the exchange then my insurance cost will have really skyrocketed for my family. Can i keep my current policy that I purchase on my own in 2014? I keep hearing about no more than a 2000.00 deductable per member. Does that include all policies that are sold off the exchange? I also keep hearing about household income. My senior in high school has an after school job that she made a little under 9000.00 in 2012. I can claim her as a dependent but she will file her own income tax. After we find out what our AGI is, are we required then to add her 9000.00 income on top of our AGI income to determine eligibilty for the subsidy? I know we would not add her income to ours for tax return but I am asking if her income is added to ours for eligibility of subsidy. I cannot find any place on the web that says if your dependent children that have a after school job, that are still in high school or college, if their AGI is added to yours in determing eligibilty for subsidy. You also mention that to get your AGI down you can deduct IRA. I deduct half of self employment tax as allowed, as well as my health insurance I buy for my family. Is that also included to bring AGI down for the exchange as well. What about a health saving deduction under adjusted gross income bracket on taxes. I am thinking that if i cannot get my AGI down enough then this affordable care act insurance will not be affordable to me. Thank you for any information that you can give me. I appreciate it.

    • Next year, insurance plans are going to have to meet actuarial equivalence tests. These are shorthanded as Metal Levels. A Bronze plan will have a 60% equivalence. That means the plan will have to cover a certain percentage of a defined set of essential health benefits, up to some point where everything is covered in full. However this mix is set up, the overall plan has to be meeting a 60% coverage test. (This does not mean you pay 40 and the insurance company 60, but that the overall coverage before the catastrophic coverage kicks in is like that.)

      Silver plans are set at 70%; Gold plans at 80%; and Platinum, at 90%. Presumably, the more coverage, the more it costs.

      Plans can offer different levels of deductibles. There is some maximum allowable deductible, though.

      It isn’t clear to me, from what you described about your current plan, what its actuarial equivalence is. It may not be 80%. I bet you can find out from the right person in your insurance company.

      As to AGI, nowhere in the act does it say that the childrens’ AGI is rolled up into the parents’. Proper retirement planning can help you to reduce AGI in any given year, and this may now be critical for some people who are close to the 400% FPL mark. We advise about that sort of thing in the firm I work for.

  36. Our state decided to let the Feds run our exchange. We are a family of 5, not married but we have two children together and one from a previous relationship. We live modestly on around $35,000 per year. I have wondered how the new health care act will affect us and what it will cost. The children are currently covered under Kids Connection, but neither me or their father has any health insurance and cannot afford the plan offered though the employer.

    • You will have to sign up for insurance by January 2014. If it’s your employer’s one, and it’s “unaffordable” by definition of Congress, then you get the Premium Credit. You may also get cost sharing credits depending on your AGI. If you do qualify for the Premium Credit, be careful that your income doesn’t jump too much year-to-year.

  37. Thanks for all the great info. My question: my husband and I will both turn 62 in 2014. He has had heart attack and not in best of health but works when he can but only earns up to $1300. I am the major breadwinner and we get health insurance thru my work costing me about $400 a month. My hope is to have us both retire at 62 to hopefully have some time together while healthy. Our only income will be the SS $1280 each per month. Will we be eligible for the medicaid plan in Pennsylvania under Obamacare? Since our income in 2012 was obviously much higher than it will be going forward at retirment? Due to his illness and our lack of income we also took about $20000 out of my IRA to get thru the years expenses (we hope to sell our house, pay off everything and buy a $90000 mobile home where our rent will only be about $600 a month).

    • 1) If your AGI is over 100% federal poverty level (FPL), you can get insurance on the Exchange, with a federal credit. (Feb. 2013 number for family size of two: $15,510).

      2) Our illustrious governor and his buddies in the Legislature haven’t said they will do Medicaid Expansion for Pennsylvania. This means you might be out of luck if you don’t have ENOUGH income to be at 100% FPL in years after 2014.

      3) The firm I am working for in Elizabethtown would be happy to do your taxes. DM me.

  38. I’m on disability from my company…..I’m considered a retiree. I have a 19 year old daughter on my policy. My employer reported the cost of my medical coverage at $28,000. I made $9000 last year from them as a vested employee….This makes no sense and the policy pays not ONE dime towards my medical care as its considered only a coordination of benefits for me……even after I meet my deductible. In this $28,000 that they reported…..I pay $257 a month as my premium….That comes to $3084 a year in premiums for me…Again this policy does not pay out one dime for my coverage. My total income per year is $16,000. Am I really suppose to believe that my employer is paying $26,000 for a policy that pays out nothing for me?????????

    • It’s hard to say if your policy costs $28,000; but, if you can’t really use it, how much coverage do you really have? When Obamacare kicks in in January, there will be “essential minimum benefits”, and an out-of-pocket cap on annual expenses. Certain preventive tests will be free.

      • Exaxctly….if its not paying anything towards my medical costs why would my company pay this much for this policy for me. One of their full time employees that I know and who’s plan has more coverage than mine…His total costs was reported at $5000. They reported $5000 on his W-2 for medical costs and $26,000 on mine for me…. a retiree that gets less coverage….I don’t understand.

  39. Seriously, I have paid approx. $300 for mediocre coverage now i’ll have to pay over $500 under ObamaCare for BARE MINIMUM coverage – not sure what your thinking…

  40. My Father has health insurance thru his employer but my mom is self employed and doesn’t have insurance at all. She is eligible to be on my Dad’s insurance but the cost is prohibitive to them to do so. Since combined they make roughly $55k gross how does this affect them. Will my Mom be forced onto my Father’s insurance?

    • Probably. Your mom has to be covered, and the only question will be if your dad’s employer policy is deemed “unaffordable” under the rules. I think, if he would have to shell out more than 8% of MAGI to cover your mom on his policy, it would be. An alternative may be that she gets an exchange policy. There might be a penalty to the employer, then, for not offering affordable coverage. This is why they never should have jerry-rigged a new plan on top of employer-based insurance. They should have given everyone the opportunity to go right to the Exchanges.

  41. Hello! Thank you for this wonderful site!
    I am 58 1/2 years of age and have an individual policy with Anthem that just went up to $479.00 a month, allowed 3 doctor visits a year where I may use a co pay, wellness visits covered, deductible is $5000.00. I am in the process of a divorce, no children, 8 year marriage to a doctor. I have been a homemaker for the eight year marriage. I believe you stated that for me to enter the exchange they would take my income from 2012 to assess my premium. At that time I was filing taxes jointly with my husband showing income at about $100,000. I am now unemployed and looking at retraining for 6 months and finding a job probably at about $10 to $12 an hour no health insurance. We will be splitting our assets and the best case situation for me will be $350,000 cash/IRA, no alimony or temporary maintenance.

    Will my AIG be calculated by what my husband made in 2012 or will my AIG be calculated by my homemaker status.
    Thank you for your help in understanding this.

  42. First Thx Again for your great site How much data sharing of information does the IRS and Medicaid do If someone on medicaid rec. $25,000 as a gift And being the giver has to report any amount over $13,000 on their taxes ( with the name of the person they gave that amount to)
    Also if someone is self employed and their income varies from year to year from being on medicaid and high enough to buy from the exchange from one year to the next Will they just keep going back and forth – Thx Again Sunny, Really Enjoy all the info and ?s on your site

    • My understanding is that, going forward, Medicaid will be purely income-based. NO asset test.

      For people with varied incomes, like many self-employed people, I could see a situation where they would have to move from the Exchange to Medicaid, and back (and forth). This is an administrative problem for a future Congress to unwind, since the law is written as it is to start. They never should have delayed implementation to 2014, but that was politics. All that would have been worked out already.

  43. Think we are probably just above the 400% FPL……..so is there anywhere where I can get some idea of how much a policy is going to run for my husband and I, both age 58…..so much talk of the subsides if you are UNDER the 400% FPL are scaring me……..then I saw this recently:

    Dated Jan. 31st , 2013. :
    http://cnsnews.com/news/article/irs-cheapest-obamacare-plan-will-be-20000-family
    “In a final regulation issued Wednesday, the Internal Revenue Service (IRS) assumed that under Obamacare the cheapest health insurance plan available in 2016 for a family will cost $20,000 for the year.”

    That is $1,666.00 a month! YIKES….that is scary! So if you are at 401%FPL……your really will pay $1,666.00 a month??? And can you estimate exactly how much of a subsidy you would get for this specific $1,666.00/month Bronze level if you were within the 300-400% FPL ? I am having problems figuring exactly how much, percentage wise, these subsides will be contributing to total premium cost. (Sorry, lots of questions there!)

    So , is there a chart somewhere to show what a husband/ wife (58 years old) would pay on that bronze plan…….??? I need some reference on what people in general who are OVER the 400% FPL will be paying for health insurance.

    Thanks so much, this is one of the best sites for explaining the ObamaCare specifics that I have come across!

    • What is critical is that, if you can, you stay under 400% of modified adjusted gross income (MAGI or “Maggie”). The Section 36B premium credits only apply when MAGI is between 100% and 400% of federal poverty level. For a family of four, this is about $94,000, using the new February 2013 HHS poverty guidline.

      • I really can’t believe a law was written that makes people do everything possible to get under the 400% level and if they can’t quite do it they will pay 3X as much for health care thru the exchange and end up making a lot less than the lucky one who just got under the 400%. No wonder the Republicans fought this.

        • The Republicans fought to keep the subsidies to just below 300%, not 400%. The Republicans did everything they could to set traps and sabotage Obamacare. And the whole structure of the program was really THEIR proposal in the 1990s, to begin with!

  44. I have read about a supposed glitch that was somehow overlooked when Obamacare was passed. From what I understand no more than 9.5% of AGI will be paid for premiums,but this is based on an individual premium,nt including a spouse or kids. I retired early and as a result pay a larger prorated amount. Also my former employer imposed a cap on premiums that was reached in 2005 and as a result my wife and I will pay any and all increases in premiums from that year forward. We both work part time now. For 2013 our portion of the premiums is about $11,200 for the two of us,about half for me and half for her. Our AGI for 2012 is about $50,000. Is that supposed glitch only going to allow credits based on individual coverage only and not include the spouse,the way I understand it? Thank you for any input.

    • If you did not have the policy, you would be required to buy on the Exchange, and pay—net of the Obamacare credit— no more than $4,750 (if we use $50,000 MAGI for 2012). Your policy costs much more than $4,750, so it is not “affordable” according to the Act.

      I am not aware of any section of the act (and I’ve read quite a bit of it) that requires you to hold on to an unaffordable policy, when an affordable one is available. It’s also not clear that your plan will be grandfathered for 2014.

      Not knowing all the facts, it sounds like you will be no worse off, and potentially better off if you can pick up an alternate policy with better coverage for less money.

  45. Sorry, I will try again. I have a question about a glitch in Obamacare. From what I understand from what is deemed affordable is based only on individual coverage and does not include a spouse and/or kids. Therefore if an employer only covers an individual on health insurance the remainder to insure additional family members would not be eligible for any credits even if the total cost was well over 9.5% of AGI. Is this the case?

    • No, that’s not how Section 36B reads. Affordability is based on the taxpayer and spouse when the couple file as “married filed jointly”. Junior’s AGI is thrown in, if junior is included in household size to determine the federal credit.

  46. My son is married with 1 child. His Gross Annual Income is about $45K; his wife last year reported wage was under $10K; His employer offers a medical plan which would cost them about $750 per month. Based on the above this puts them at 281% over the proverty level for a family of 3. He has significant amount of debt (house payment, car payment) to the point in which he has nothing left. Where does this put him on the Obamacare chart does he go into an exchange? Is the employer required to pay the medical insurance or is that a pass through to the employee? What happens when the employer pays a portion and the employee is required to pay a portion of an employer plan.

    • I think he will have to pay up to 9.5% of his and her overall income, as measured by MAGI. If the employer pays part of it, he may still be on the hook up to 9.5%.

  47. I am self employed and posted a question earlier about if your teenagers or college students AGI would be added on to the parents AGI to determine eligibilty for a subsidy. You had responded that no where in the act does it say the childrens AGI are rolled into the parents AGI. I noticed a recent post (Feb 10) something about Juniors AGI will be added on as well.
    So if your teenager, college student, lives with you, has an after school job, and you claim them as a dependent, and if they are being included as part of the household number then their income is added on to the parents for determination of subsidy? Sorry, I am just a little confused and trying to get all the information I can. Thank you for answering questions from all of us. I look to your site often for answers, and I appreciate all that you do.

    • J. Baldwin, my understanding of the law is that if Junior isn’t being included to determine family size, then Junior’s income isn’t included. I stand corrected if I had implied that there weren’t situations where Junior’s income would get added into the family income.

      • The law states that a family’s household income includes the aggregate modified adjusted gross income of all family members who are required to file an income tax return. A child who is claimed as a dependent on parent’s return is required to file only if his/her income is greater than $5800. Therefore I assume if amount is less than $5800 it does not get added to household income. Do you think I am correct?

        • It seems to me that the dependent’s income is only included if the dependent is listed as such (that is, a $3900 deduction) on the main taxpayer’s return. I doubt Congress would have written the law in a way that confiscates Junior’s income, although for college financial aid purposes, there are some circumstances when it can take quite a hit.

  48. [Update #2 6/30/12: What is "household income" for purposes of the Affordable Care Act?...I don't know if they ever fixed that loophole where the seniors who retire at 62 can collect social security and have it not count as income if it's off the tax return.]

    1. If a senior starts collecting Social Security at age 62, is that counted as part of household income?
    2. Where can I see the loophole you mentioned?

    Thanks!

  49. Hi, thanks for this very informative site. I’m wondering: I am self-employed but my income varies each year and is hard to predict. The last few years have been under 200% poverty level, but in 2012 was much more than usual, unlikely to be that high again. I also had an additional part-time job that I no longer have, so that increases the AGI even more. Will there be an option to reflect that you no longer have a job that you had last year? And is there any way for a self-employed person to show that the previous year’s taxes are not reflective of typical income? Thanks for any information.

  50. You stated that the glitch in Obamacare with social security has been addressed. Can you elaborate on that for us? I have hunted high and low and can’t find a thing on this anywhere. Is social security income now counted only if it is taxable ? Husband is 66 collecting ss, I’m 61 and unemployed (lost job 2 yrs. ago), AGI is below the 138% FPL without social security (his ss is not taxable this yr. So do I add his untaxed social security or any part of it to the AGI to figure what my premiums may be?

  51. After surfing the net for hours on end, I finally found my answer. Social Security in it’s entirety will be counted in the MAGI. Here is the quote for the govt. website I discovered online:

    On November 21, 2011, President Obama signed into law P.L. 112-56, which will change the
    definition of income for these programs and include non-taxable Social Security in the definition
    of MAGI.

    It will now be simpler to get an approximate idea of what our premiums will cost.

    The government is doing an extremely poor job educating the public with facts. For instance in all the surfing I did on this subject I ran across two places where it states that a married couple filing separately will NOT be eligible for a subsidized plan. I know of two couples myself who normally file separately and I’ve already told them what I read today. Had they went ahead and filed that way again this year they’d be in a jam regarding insurance when they applied. Married people have to file jointly to qualify.

    I also heard on radio and saw on tv that the govt. has put a stop to admitting any new people into insurance programs that have pre existing conditions because they don’t have enough money to cover them through 2013. If they’ve already applied and were accepted ….no problem…..but no more newbies for the rest of the yr. Also heard 26 states have opted out now that the deadline has passed. How in the world is our govt. going to get exchanges up and running in those 26 states, who is going to pay for all the people needed to set up these govt. exchanges in the states.

    This is a mess! I don’t envision a smooth transition, it looks like it’s going to be much more costly than Obama promised when he said our premiums would be reduced by $2500 per family.

    Taxes are going to THE MOON ALICE!!!!!!

    • Glad I was able to point the way.

      No one knows what the exact prices for insurance will be in 2014. The benefit of the new law is that, for most of America, the Exchange price will be set (net of federal credit) at a certain percentage of income. “Modified adjusted gross income.”

      This is a real benefit; but, like most tax code benefits, people will only realize it when it’s explicitly pointed out as they file in 2015.

  52. This is THEE most exciting and informative site, I’ve encountered about something so vital to my future.
    My question: how will my 2012 income look as for qualification of AGI for the 2014 rollout?
    I am a 55 yo widow. My 56 yo husband died of pancreatic cancer last October 2012. He lived 7 horrid months from diagnosis on March 13. 2012. He was on California EDD(short term disability-non taxable) when he could no longer work 3 weeks after diagnosis in April. His total AGI from wages for 2012 was $22,000. I have not filed 2012 taxes yet, but I assume(?) it will be as married filing jointly as in the past.
    I have not worked since retiring with no pension to take care of him. I still have no income except to live off the investments we made over our 37 yr marriage. I currently draw $31,000/year from those investments to live on. I pay $516.00/mo for my health insurance (single coverage) through COBRA from my husband’s company. I have no dependents. I will not be eligible for SS Widows Benefits until, at the earliest, when I turn 60.
    What will the picture look like for me to get into one of the Fed’s exchanges next year and at what rate will my income be judged? My (new) permanent address is South Dakota, a Just Say No to anything resembling fairness state.

    • Hoofin’- I know you said that you cannot reply to every question, but if you have time, can you look at my question above and maybe point me to a post in which you have answered a similar question? thank you

      • Sorry I can’t answer every question left here in a timely matter. As I’ve been saying, I work in taxes and tax planning, and so I am, in some sense, competing against myself. When I wasn’t, it was more of a public service for whatever instructional value it add.

        To answer your question, it sounds like you will be considered a “single” person for exchange purposes, even if you file jointly for 2012. If this is so, you will want to look at your taxable income as a single person (that is, no asset test for the Health Insurance Exchange). If, for some reason, you are being told that the test is on joint income, then you should also be able to rely on federal poverty level numbers for a couple, not for a single person.

        You can easily find “federal poverty guidelines” on an internet search.

  53. I’m sorry I really don’t understand. My husband and I make less then 30,000 a year. We are retired and have medical insurance through my employer which is a police dept. we pay 1060.00 a month for health insurance. They pay 88.00a month for us. We are under 60. How much will we have to pay now for 2014.

    • If you are retired, then how do you have medical insurance through your employer? Do you mean your old employer?

      It will probably be that you can either keep your current policy, or (if it’s more than 9.5% of your MAGI income,) buy from the Health Insurance Exchange.

  54. If I no longer loose my insurance when my employer fires me , why wait? Why not quit right away and go surfing? The marginal difference between being a poorer partial freeloader and a sucker who works in a cubicle for those who will choose to freeload is getting quite a bit narrower.
    I mean what does the majority think? That people won’t notice the taxpayer money offered on a silver platter?

  55. Pingback: The republicans need a time out. - Page 2 (politics)

  56. I wrote a long comment 2 days ago about the “payback” clause in the law that nobody seems to be aware of. I’m disappointed that the owners of this blog have chosen not to post it for those who want to learn how this law may or may not affect them in the future. The “payback” clause is a major issue and will definitely affect many Americans who will be getting subsidies in 2014 but the effects of moving either up or down on the FPL scale won’t be realized until those taxes are filed a couple of yrs. down the road. Why would you choose not to make people aware of this by not posting my previous comment? I’m well aware that you are much in favor of ACA but let’s not candy coat everything here and bring some of these issues to light so that people may prepare themselves.

  57. What are states that will not institute Medicaid expansion going to do for those under 138% of FPL who are now ineligible for Medicaid ? It couldn’t be that those with incomes between 139% & 400% (or is it 100%-400%) of FPL will be eligible for premium subsidies for policies on the new exhange, while those without Medicaid and under 138% of FPL will be forced to buy a policy at full cost, could it? I’ve read through a lot of your site (how wonderful of you to give so much of time and expertise to others!) and I only found one comment that made it seem like you had a thought about what SHOULD happen,

    [Update: It isn't clear whether, in states that don't adopt Medicaid Expansion,
    whether their people under 133% of poverty level can go to the exchange and
    get the subsidy there. At $14,800, an exchange policy is $297. Why can't they
    just offer that price for people below $14,800?]

    But has any of these states or the federal gov’t addressed this situation or discussed possible plans? I’m from Florida and have a feeling the right wing legislature will differ with our governor’s recent change of heart (turns out he had one!)

  58. What are states that have decided against the Medicaid expansion doing for those under 138% of FPL who aren’t currently eligible for Medicaid ? Could it be that those with incomes between 138% (or is it 100%) & 400% of FPL will be eligible for premium subsidies for policies on the 2014 exhange, while those without Medicaid and under 138% of FPL will be forced to buy a policy at full cost, could it? I have searched through most of your blog (so wonderful of you to give so much of your time and expertise to help the ignorant and confused!) and found only one comment on this topic, but it was more what you think SHOULD be, than what has been instituted or discussed as a remedy:

    “[Update: It isn't clear whether, in states that don't adopt Medicaid Expansion, whether their people under 133% of poverty level can go to the exchange and
    get the subsidy there. At $14,800, an exchange policy is $297. Why can't they
    just offer that price for people below $14,800?]”

    Do you know of any states with a plan to address this? I live in Florida and fear the right wing legislature will disregard the governor’s recent change of heart (was shocked to find out he had one!) and vote against expansion.

    • That is the problem. There are no premium subsidies for those below 100% of poverty level, since the assumption in the law was that all the states would have to expand Medicaid or else lose all Medicaid funding.

      • None of the states have worked at all with the feds to have the Medicaid money used for subsidies instead? None of the states have committees who are working to address this issue? If it actually ends up that those at 4x the poverty line get subsidies while those at one fourth of the PL pay full price (or go without) than it is just ‘through the looking glass’!! Right now as a single 58 year old with a pre-existing conditions,having lost my job and employee health insurance and running thru COBRA, I was quoted something like $1300/mo for full coverage. I was forced to just go with a catastrophic policy for around $200 that covers everything but doctors & medicine (a donut hole plan as opposed to the whole donut plan) If Florida fails to vote for expansion and I remain in the Medicaid cracks, boy how I’d like to be able to buy a full coverage policy for the $297/mo. that, as you say, people right at and just above the poverty line will be able to. Instead here I am with two strategies: crossing my fingers and wait for the Florida legislature to act or look toward moving to a state that has more allegiance to the U.S. government of the 21st century than to the Confederacy of the 19th. Thanks again Hoofin for your time, effort and good works. Gene M.

        • I appreciate your comments and admire how you closed the comment: more allegiance to the U.S. government of the 21st century than to the Confederacy of the 19th!

  59. How are the premiums going to be collected for people on the exchange? Will it be through their employer paychecks?

    • No. It would not go through the employer. My guess is that there will be an automatic debit feature when people sign up. Otherwise, the classic bill in the mail. The Obamacare credit, though, will be applied against the balance due, and you only pay the difference.

  60. You are an intelligent fella, but your references to the South and the Confederacy to those opposed to Obama undermine your credibility. State’s rights are not a casual issue to be dismissed by tying those against Obama Care as some sort of racists. There is enough on the table with Obama Care to have a reasonable discussion. This is a very serious issue as it effects a large portion of the economy and puts the government in control of people’s health, not just health access. So, stick with your rebuttals without making those you disagree with into confederate flag waving no-nothings.

    Now, a question. There have been many discussions about the consequences in the event States do not take the medicaid expansion. I have not seen much on what happens if a State decides not to set up an exchange. My understanding, since the Feds will set up the exchange, all the mandates do not apply nor will subsidies be given resulting in an illusory system. Seems like it was an intended loophole designed to give States the incentive to set up their own exchanges. So, is this true and if so, how many states have stated their intent, at this time, not to set up exchanges?

  61. I have two more questions:

    1. Do the rules and regulations of Obama Care apply to policies sold outside the exchange? My reading so far seems to indicate that certain rules, like the contraception mandate and the 85% rule do apply to all policies, but that some rules might not. In other words, if one says they do not want to be on the exchange because they do not want to be subject to federal rules (e.g. fear of rationing) would that be a misplaced fear since the rules apply to all (disregard whether rationing is a legitimate fear)? Let me be more clear. If an advisory panel under Obama Care decrees that that those over the age of 70 will not be eligible for a kidney transplant (and please, I am not trying to argue that it will come to this) then does that apply to private insurance policies or do they continue to make their own rules as far as limits on coverage.

    2. I have a law practice in Missouri with 9 employees four of which are attorneys and of the four, three are partners. Obviously we are not under the mandate but look to take advantage of Obama Care to do away with insurance. We have provided health insurance under a group policy. We have, for various reasons, paid 100% of the premiums. Of the ten employees, 1 partner is on medicare, 3 partners are on the group health plan at the firm (although one of the partners can easily go on her husband’s insurance) and then we have three other employees who have family coverage and two other employees who might ask to enroll in the near future. Our annual cost is $65,000 which is a lot of money for a small town firm. And I imagine when there is a rate renewal in September we will see a 10-20 percent increase. Now, my goal is to do away with the insurance entirely even though we could lower our contribution. If we did that, it is like a pay cut to those who would now have to contribute since we have already created the precedent. Obama Care offers the opportunity to save the firm money and shift the cost to the taxpayer. Now, Missouri has failed to set up a State Exchange but I will assume that subsidies will be available under a Missouri federal exchange despite the law being written to the contrary.

    I believe based on their income and dependents, the non-lawyer employees would all qualify for some sort of subsidy. We could make up the difference with pay raises to make it worth their while, especially since our coverage has a $5,000.00 deductible and is a 70/30 plan. It could be a win/win situation for our employees and the employers. One attorney attorney will continue with Medicare, the other will go on her husband’s insurance. I, myself will go on the exchange as I qualify for subsidies due to the fact that I have a heck of a lot of children. The fourth attorney may qualify for some subsidies as well. For example, if I pay for my own insurance, my costs will be reduced in half for insurance. When you look at the savings from eliminating the group plan, I will net an extra ten thousand in profit after the cost of me paying my own insurance. For the attorneys who do not need to go on Obama Care like the attorney on Medicare, he will be reacher to the tune of $20,000 per year.

    So, several questions. I have no idea how to go about this. It is extremely complicated. Right now I am having my taxes done with an I towards reducing AGI. When do people enroll, how long is the enrollment window? Do we have to terminate our insurance before they get on the exchange to qualify for the exchange. Do you have any advice from a business perspective to avoid these exorbitant costs? Any help is appreciated.

  62. I live in Florida. My AGI for 2012 for $5373. I am unemployed and my unemployment ran out a year ago. I will turn 62 in February 2014. I do not qualify for Medicaid currently because my assets are to high. If Florida does not accept the Medicaid Expansion then I will not be able to file on the exchange in Oct 2013 ? I am currently paying $673/month $5000 deductible for health insurance. I will probably have to cancel the policy because my it is too costly. I plan to collect SSI in Feb. 2014. I take care of my elderly Mother (87) who suffered a stroke !4 years ago. We have spend the summer in Delaware (6 months) at her home. Should I give up my homestead in Florida for the health benefits. I could easily become a legal resident in Delaware. My property taxes would probably only go up $1000/year. I can not afford the premiums for health anymore. I have filed Delaware part year nonresident taxes for at over seven years?

  63. I live in Ohio with my husband and two children. Our AGI is 30K. My kids are on medicaid and neither my husband nor I have health insurance. It’s really tough to find a provider here who takes medicaid. What will we have to pay for all 4 of us to have coverage and will it be the medicaid the kids have now?

    • You will most likely get a family policy through the federal exchange, and pay about $600/year if you are at $30,000 AGI in 2014 (130% of poverty level for family of four).

      • A second probability, since you are near the 138% AGI mark, is that your whole family will qualify for the new, enhanced Medicaid, which will likely be accepted by many more Ohio practitioners if they want to put food on their table.

  64. Hi Hoofin!
    Could it be when you say in your initial post that “At $14,800, an exchange policy is $297″ that you mean per year. Till now I’d assumed it was $297/mo. but looking at the graph from that post it seems that it would have to be $297/yr. That translates to under $25/mo.! Could that be right?

    This year I will likely be around 70% to 80% of FPL and in a state that now looks to have rejected the medicaid expansion, so I’m trying to guage what I might have to pay in 2014 if I receive a subsidy. I know I shouldn’t be looking at the subsidized costs since they’re not for folks between 138% and 400% of the FPL – that the new Medicaid was intended for us; yet although the expansion’s rejection defies common sense, I’m still optimistic that somehow the state and federal gov’ts will figure a way to make sure that those of us under the FPL, at the very least, will get the same subsidy that the folks making more will get.

    Currently, with a $200/mo. ‘catastrophic’ plan and its $10K deductible, I’ve been putting off getting needed surgeries since they would cost me close to my maximum of $13K out-of-pocket (hurts more than the physical pain to think of paying an amount in excess of my annual income to get things repaired) and instead, I along with my pre-existing conditions, have been waiting patiently till 2014 to finally be allowed back into the comprehensive health insurance market.

    So to doublecheck, if I wind up getting the biggest subsidy does that mean the policy will cost me $297/yr? And if it’s my worse case scenario where I have to pay a non-subsidized amount, what would an individual policy cost? Your chart ends with those at 400% of FPL having to pay $4500. Does the non-subsidized plan jump up considerably at that point or would it be fairly close to the $4500 cost?

    Thanks so much for your time and insight
    G.M.

    • It is $297/year.

      If you do not have at least AGI of 100% FPL in 2014, you would not be eligible for the Section 36B (health insurance) credit. That is one of the ironies of how the law is written: it assumes everyone under 100% FPL will be in Medicaid.

      From what I’ve read and seen, it looks like the administration is going to sign people up based on what the applicant believes he/she will make in 2014. That’s in addition to the current regs, which use the 2012 AGI. They are obviously trying to get around people being stuck with a clawback on the credit in 2015.

  65. Thank you for all the information re: Affordable Care Act. Very complicated info out there on the web. My husband is 63 and he retired at 62; His income in 2012 was ss. I retired in March of this year and benefits will not start until August 2013. I am carrying our insurance through COBRA at the rate of $1164.00 per month currently. We have lived frugally and planned for early retirement but never imagined the current insurance costs! Since assets are not counted in the insurance cost equation will our income from 2012 or 2013 determine where we fall on the scale/cost of coverage? Thank you again for your time and informative blog.

    • Based just off what you tell me here, yes. If you are only living on early social security (which is added back to AGI to determine “MAGI” or modified adjusted gross income for Obamacare), then you should qualify for a Health Exchange credit. At 65, of course, you would get Medicare if you have the credits. But between 62 and 65, not only would you need Obamacare, you would have to enroll in some kind of insurance.

      In January, it goes from “will an insurance company offer me affordable insurance?” to a statement: “I have to have affordable health insurance.”

      When the Health Insurance Exchange is up and running in your state, at the start of October, you should be able to price a policy, which, with the Health Exchange credit, would be substantially less than $1164 a month.

      Maybe Obamacare is coming in the nick of time for you?

  66. Thank you for the quick response. We reside in Tennessee and our state is relying on the Federal government program. We anxiously await the October date to enroll for the 2014 coverage and health credit. There are many others like us who have retired early only to be denied affordable coverage due to pre-existing conditions(controlled Diabetes!) We could get coverage but the premium we were quoted was almost the same as our COBRA plan which we can carry for eighteen months. Thanks to the Obamacare program now hopefully we can save some of the insurance costs difference to really enjoy our retirement instead of dreading the huge payment monthly for the COBRA plan. Like you stated, just in the nick of time! Again, thank you for answering questions and being an educated voice to those of us who need help understanding the new healthcare program.

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