Affordable Care Act Launch & Qualifying Income Support Levels

Affordable Care Act Launch & Qualifying Income Support Levels


By Phil Castell

Tomorrow is the start of the enrollment period for the Affordable Care Act (ACA)!   Hopefully the official exchange website will be able to handle (what is anticipated to be) a huge volume of internet traffic from folks shopping anonymously and those ready to purchase.

The website address is but be careful.  There are a  few sites with similar names that are not the official site, but rather sites run for commercial purposes.

As I write this on Sunday, everyone from agents to navigators are eagerly awaiting the launching of the live version of the website see exactly how it will perform.  For the past three months, there has only been access to screenshots of what we assume the website will look like.

Let’s recap a couple of basic facts regarding the new plans.

If your income is below 400% of the Federal Poverty Level (FPL), you will qualify for some level of support.  It is estimated that approximately 75% of all Clallam County residents will fall below this threshold.

If your income is below 138% of the FPL, you will qualify for the new Washington Apple Health Plan (which is the new name for Medicaid) for health insurance.

If your income is between 139 and 250% of the FPL, you would qualify for a large amount of premium support as well as reduced cost sharing (deductibles and co-pays).  Basically, this means a silver plan will act more like a gold level plan. If a person claimed to be in this group and then was later deemed to be over the 250% FPL limit, they would have to repay some of the premium tax credits taken, but would not have to repay any of the reduced deductibles and co-pays.  This is one of those interesting little facts that might be useful to a small group of folks.

If your income is between 251 and 400% of the FPL, you will be eligible for a reduced premium through premium tax credits.

A word of warning is necessary here.  If you take the full credit available and your income on your tax return is more than anticipated, you may have to repay some of the credits you claimed.

We do know that the process for applying for coverage within the exchange will require you to provide far more information than purchasing outside the exchange.

Why is this?  In order to guestimate the level of premium support you are eligible for, you will have to provide personal information in far greater detail.  In what we call “Uncle Sam has hired Big Brother”, the government has contracted with Equifax to help verify your identity.  Equifax is one of the big three credit bureaus in the credit reporting business.

They did this because it’s widely recognized that some items generally used to verify identity are not as private as one would assume or hope for.  For example, how many people or businesses have your date of birth and Social Security numbers?  Probably far more than you would imagine.

So, if you are on the Exchange website and asked random questions you think the government shouldn’t know answers to, they do because of their relationship with Equifax.

If your income is over 400% of the FPL and you decide to purchase a plan outside the Exchange, the paperwork to enroll is far easier.

Here are a couple of tips that might benefit you as you review your options.

Purchasing within the exchange with dependents under age 19 means you must buy pediatric dental for $26.50 per month, whereas outside the Exchange, pediatric dental is included. While benefits are similar, there is a major difference. Within the Exchange, the dental benefit only has a $65 annual deductible while outside the Exchange, the medical deductible (ranging from $1,000 to $6,250) must be satisfied before any dental services are covered.

This next benefit I classify as “strange but true”.  Pediatric vision plans state a child is eligible for one set of glasses each year, including frames.  However, it does not limit the price of the frames, so I can envision (pun intended) a whole crop of teenagers wearing some really fancy designer frames.  I would assume this is an area that might be tweaked prior to the following benefit year.

Good luck and happy searching out there!