|Federal Poverty Level (2011)||Income||Premium Contribution as a Share of Income||Out-of-Pocket Limits||Actuarial Value: Silver Plan|
|<133%||S: <$14,484||2% (or Medicaid)||94%|
|133-149%||S: $16,335||3.0-4.0%||S: $1,983||94%|
|F: $33,525||F: $3,967|
|F: $55,875||S: $2,975|
|250-299%||S: $32,670||8.05-9.5%||F: $5,950||70%|
|300-399%||S: $43,560||9.5%||S: $3,967||70%|
|F: $89,400||F: $7,933|
|≥400%||S: >$43,560||—||S: $5,950||—|
|F: >$89,400||F: $11,900|
Four levels of cost sharing:
Catastrophic policy with essential benefits package available to young adults and people whose premiums are 8%+ of income.
NOTES: Actuarial values are the average percentage of medical costs covered by a health plan. Premium and cost-sharing credits related to silver plan. F = family; S = single person.
For additional details, see The Commonwealth Fund Health Reform Resource Center: What’s in the Affordable Care Act? Available: http://www.cmwf.org/Health-Reform/Health-Reform-Resource.aspx.
SOURCE: Collins et al. (2012).
By expanding coverage to those who are currently uninsured and by setting standards for health insurance benefits, the ACA seeks to limit not only the economic burden of medical care expenses, but also the risk that individuals or families will forgo needed medical care because of the cost or be at financial risk if they should become sick or injured during the year.
Note that the ACA provisions and poverty thresholds for tax credits for premiums and enhanced benefits apply to people under age 65. Current policies are quite different for those aged 65 and older or disabled and eligible for Medicare. As illustrated in Figures 2-1 and 2-2, for people eligible for Medicare, the threshold for eligibility for full Medicaid coverage ranges, at state option, from 75 to 100 percent of poverty for those who are aged, blind, or disabled. For those with incomes at or near poverty,