Everything You Need to Know about Obamacare Cost Assistance 2019
Below is a break down of everything you need to know about cost assistance on 2019 health plans under the Affordable Care Act (ObamaCare).
In other words, here is everything you need to know about Premium Tax Credits, Cost Sharing Reduction Subsidies, Medicaid and CHIP, HSAs, and Medical Deductions for 2019 all in one page.
Types of Assistance
First off, the types of assistance offered under the Affordable Care Act are:
- Premium Tax Credits
- Cost Sharing Reduction Subsidies (Silver Plans only)
- Medicaid Expansion and CHIP
- HSAs (Health Savings Accounts) and Medical Deductions
TIP: Want to find out what you can save quickly, check out our Subsidy Calculator.
The 2018 Federal Poverty Guidelines Used in 2019
Below are the 2018 Federal Poverty Guidelines that went into effect on January 13, 2018. These guidelines are the key to all cost assistance under the Affordable Care Act, specifically these guidelines are used for:
- Medicaid/CHIP between Jan 2018 and Jan 2019.
- 2019 marketplace cost assistance on all marketplace health plans held in 2019 and purchased during open enrollment for 2019 (which starts in 2018, and which is why it uses the 2018 levels).
- For special enrollment in 2019.
- For ACA taxes for the 2019 calendar year filed in 2020.
TIP: Alaska and Hawaii use different guidelines (see this link to guidelines as published on HHS.Gov). See a list of all guidelines on our Federal Poverty Level Page.
|2018 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA|
|PERSONS IN FAMILY/HOUSEHOLD||POVERTY GUIDELINE|
|For families/households with more than 8 persons, add $4,320 for each additional person.|
TIP: The 2018 poverty guidelines are in effect as of January 13, 2018. See also the Federal Register notice of the 2018 poverty guidelines, published January 18, 2018.
Details on Each Assistance Type
Below are details on each type of cost assistance for 2019
Medicaid and CHIP for 2019
In all states that expanded Medicaid adults making below 138% of the poverty level qualify for Medicaid ($16,754 for an individual and $34,638 for a family four). Other states have unique eligibility. CHIP eligibility tends to be higher but differs by state. Contact your state Medicaid office or use the marketplace for details.
The Premium Tax Credit Subsidy Caps By Percentage of Household Income for SLCSP 2019
Premium tax credits are tax credits that can be taken in advance as Advanced Premium Tax Credits or at tax time as Premium Tax credits (or you can do a mix). Premium tax credits cap premium spending for a family based on MAGI income compared to the federal poverty level and are based on the cost of the second lowest silver plan (SLCSP) in a state’s Marketplace. To qualify you must purchase a marketplace plan.
The chart below shows the minimum and maximum percentage of the household income that a person will pay for that plan. The amount you’ll pay is based on your household income (compared to the federal poverty level) and is adjusted based on the price of the plan chosen.
The premium tax credit caps for 2019 work this:
- Less than 133%, then the initial percentage is 2.08% and the final percentage is 2.08%;
- At least 133% but less than 150%, 3.11% and 4.15%;
- At least 150% but less than 200%, 4.15% and 6.54%;
- At least 200% but less than 250%, 6.54% and 8.36%;
- At least 250% but less than 300%, 8.36% and 9.86%; and
- At least 300% but not more than 400%, 9.86% and 9.86%.
NOTE: To qualify for tax credits you must make between 100% – 400% of the poverty level (FPL). If your state expanded Medicaid you will be eligible for Medicaid instead of tax credits below 133% (or 138% adjusted) FPL.
Cost Sharing Reduction Subsidies 2019
CSR subsidies reduce your out-of-pocket expenses on silver plans purchased through the health insurance marketplace for those with incomes between 100% – 250% of the poverty level.
CSR subsidies lower your coinsurance, and lower copays, deductibles, and maximum out-of-pocket costs you will pay in a policy period.
There are three levels of CSR subsidies: CSR 73, CSR 87, and CSR 94. The numbers refer to the actuarial value (AV). Benefits sheets will include different summaries for different CSR levels. Please note values may adjust each year.
Income Level Actuarial Value (the costs a Silver plan will cover due to cost-sharing reduction subsidies for % of the Poverty Level).
100-150% FPL = 94% Actuarial Value (CSR 94)
150-200% FPL = 87% Actuarial Value (CSR 87)
200-250% FPL = 73% Actuarial Value (CSR 73)
More than 250% FPL = 70% Actuarial Value
Out-of-Pocket Maximums and Deductible Limits For 2019
Each year the ACA sets new limits for out-of-pocket maximums and deductibles. Here are the limits for 2018 plans for individuals and families.
- For 2019, your out-of-pocket maximum can be no more than $7,900 for an individual plan and $15,800 for a family plan before marketplace subsidies.
- For 2019, your maximum deductible is the same as the out-of-pocket maximum.
Minimum Deductible for HSA Eligibility
- Self-only: $1,350
- Family: $2,700
Maximum Out-of-Pocket Limit for HSA Eligibility
- Self-only: $6,750
- Family: $13,500
TIP: The maximums are slightly lower on HSA compatible plans then they are in general on health plans. This has to do with the fact that the rates are raised by different mechanisms. The difference allows for non-HSA compatible high deductible plans. Thus, if you want an HSA, make sure your plan is “HSA Eligible.” Learn more about pairing HSAs with High Deductible Health Plans in 2018.
HSA Contribution Limit for 2019
- Self-only: $3,500
- Family: $7,000
NOTE: 55 plus can contribute an extra $1,000.
For 2017 and 2018, medical expenses were deductible if they exceed 7.5 percent of your AGI (adjusted gross income). In 2019, this threshold will increase to 10 percent of your AGI.