When you buy a new Affordable Care Act individual health plan, you may qualify for one or more kinds of financial help paying for your costs. Also known as a “subsidy,” this assistance is based on your income and family size, and you must re-qualify each year when you renew your health plan.
Reducing your monthly payments
One type of subsidy reduces the cost you pay each month for your plan. This is sometimes called a “tax credit” because you can receive the help either in the form of a deduction on your taxes, or an immediate reduction in your monthly rate.
In Washington, help is available for an individual with an income up to $45,960. (For a family of four, it’s $94,200.) Here’s a quick summary explaining how to qualify for and use this type of subsidy.
Lower costs when you need care
The second type of subsidy lowers the amount you pay out-of-pocket when you receive care, such as visiting the doctor’s office or filling a prescription. This is known as the “cost-sharing reduction subsidy” and it’s available for persons on the lower range of income for those who already qualify for the tax credit subsidy.
Premera offers three different types of plans for 2014—Gold, Silver and Bronze. The plans all offer the same benefits, but the amount you pay out-of-pocket towards those benefits varies. Bronze plans have the cheapest monthly rate, but require you to make the highest percentage contribution toward your care. Gold plans have the highest monthly rate, require a lower percentage contribution from you.
The cost share reduction subsidy is only available if you purchase a silver plan. It can significantly reduce the co-pay, deductible, coinsurance and out-of-pocket maximum on your plan, so you pay less when you receive care.
To get this type of assistance, you must:
- Qualify for the premium tax credit described above, and have an income not exceeding $28,725 for an individual or $58,875 for a family of four.
- Apply for the subsidy through Washington Healthplanfinder.
- Buy a Silver “metallic level” plan, such as our Preferred Silver plan.
Learn more about the cost-share subsidy in this short video from healthcare.gov.
We Can Help
Premera’s sales team can help you learn whether you qualify for financial help with your health plan costs, and if you qualify, help you buy a plan through Washington Healthplanfinder. We can also help you understand more about the cost-share reductions you may get. Call 1-877-PREMERA.
Reference Guide to Subsidies
Check out this infographic for the basics about getting financial help for both your monthly bill and your out-of-pocket costs when you visit the doctor or pharmacy.