What the Government Considers “Affordable”
For employees receiving their benefits from an employer.
If the employee portion of the health insurance the employer provides costs more than 9.5% of the employee’s income, and it doesn’t cover at least 60% (Minimum Value) of the employees medical expenses, this is considered to be “unaffordable”. If your insurance is “unaffordable” you are then permitted to see if you qualify for a Subsidy (Advanced Premium Tax Credit). If the employee’s insurance from their employer is affordable, then the employee is NOT eligible for a tax subsidy.
If you DO NOT receive health insurance from your employer.
As individuals or families, if your portion of the health insurance premium costs more than 8% of your household income, it is considered “unaffordable”, which means you don’t have to buy a medical plan “excludable.”
For individuals and families that go to the exchange to buy health insurance, IF the insurance is greater than 8% of your Modified Adjusted Gross Income (MAGI) it is considered “unaffordable” and you are not required to buy insurance. MOST Americans will find they will qualify for either Medicaid or a Subsidized plan that makes insurance “affordable.”
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What is a Health Insurance Subsidy?
A “Subsidy” is a special tax credit that you can take to help lower the cost of your monthly health insurance premiums. If you qualify for a Health Insurance Subsidy, it’s kind of like getting a gift card from the Government to help pay your health insurance premium. This subsidy is sent directly to the insurance company, which pays a portion of your premium, and you will be responsible for paying the remaining balance.
Medicaid Basics To Know
Medicaid is a health insurance program administered by the state and federal government, to provide health coverage for those who meet income restrictions or have qualifying medical needs. Medicaid can also be used alongside other health insurance coverages such as private health insurance, Medicare, etc.
What is Tier Pricing With Prescription Medications?
Your health insurance company’s formulary is a list of all the different drugs that their plans cover. Within the formulary, there are drug tiers. These tiers determine the level of coverage your prescription drug plan offers for a specific type of medication.