MY employer offers health Insurance but I pay for it. My premium is $140 a month and my deductible is $6000. I gross 18k a year. DO I qualify for a subsidy. If I lose or change my job , do I than qualify? There would be no possible way I could pay my deductible, what happens than?


Answer

Only those with Silver marketplace plans, who make less than 250% FPL, can get cost assistance to lower deductibles. However, the ACA caps all out-of-pocket limits at $6,600 for an individual and $13,200 for a family for 2015.

If your premium is less than 9.56% of your household income then you technically have affordable employer coverage. In a perfect world affordability of all plans would take into account deductibles, but this is only partially true under the ACA.

Out-of-pocket maximum limits (equal to deductible limits) under the ACA 2015:

  • 100-200 percent of FPL (Marketplace Silver Plan Only),
    • your out-of-pocket limit won’t be more than $2,250 for an individual.
    • your out-of-pocket limit won’t be more than $4,500 for a family.
  • 200-250 percent of FPL (Marketplace Silver Plan Only),
    • your out-of-pocket limit won’t be more than $5,200 for an individual.
    • your out-of-pocket limit won’t be more than $10,400 for a family.
  • More than 250% percent of FPL (All private major medical plans),
    • your out-of-pocket limit won’t be more than $6,600 for an individual.
    • your out-of-pocket limit won’t be more than $13,200 for a family.

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