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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Health Insurance Deductible
A deductible is an amount you pay before the Insurance Company starts paying. Health insurance plans will have different deductibles. You’ll be expected to pay the whole medical bill out of your own pocket until you’ve paid your deductible.
Out of Pocket Maximum
Your out-of-pocket maximum is the most you’ll have to pay for covered services in a policy period (one year), each January 1st it starts over again, and that includes cost of medications too. After you reach this amount, your health insurance plan will pay 100%.
Qualifying Life Event
If you experience a major life change, then such a change is often considered a qualifying life event. Such life events affect your existing health insurance coverage and can make you eligible to change your coverage during the special enrollment period.