TABLE 2-1 Premium Tax Credits and Cost-Sharing Protections Under the Affordable Care Act

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%
F: <$29,726
133-149% S: $16,335 3.0-4.0% S: $1,983 94%
F: $33,525 F: $3,967
150-199% S: $21,780 4.0-6.3% 87%
F: $44,700
200-249% S: $27,225 6.3-8.05% 73%
F: $55,875 S: $2,975
250-299% S: $32,670 8.05-9.5% F: $5,950 70%
F: $67,050
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:

  • 1st tier (bronze) actuarial value: 60%
  • 2nd tier (silver) actuarial value: 70%
  • 3rd tier (gold) actuarial value: 80%
  • 4th tier (platinum) actuarial value: 90%

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,



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