Premium Subsidies to Individuals

The premium subsidies to individuals will provide affordable premium credits to individuals who are eligible and families with incomes of up to 400% federal poverty level (FPL) to purchase insurance through the Health Insurance Exchange program.
The premium credits will be based on the average cost of the three lowest cost basic health care plans within that area. The cost will then be placed on a sliding scale so that the main contributions are limited to pay a set percentage of their income for the specified income tier, the tiers are as follows:
-133-150% FPL: 1.5 - 3% of income
-150-200% FPL: 3 - 5% of income
-200-250% FPL: 5 - 7% of income
-250-300% FPL: 7 - 9% of income
-300-350% FPL: 9 - 10% of income
-350-400% FPL: 10 - 11% of income

The plan will provide affordable cost-sharing credits for individuals that are eligible and families with incomes of up to 400% FPL. The cost-sharing credits reduce the cost-sharing amounts and the annual cost-sharing limits and have the effect of increasing the actual value of the basic benefit plan a certain percentage of the full value of the plan for the specified income tier, the tiers are as follows:
-133-150% FPL: 97%
-150-200% FPL: 93%
-200-250% FPL: 85%
-250-300% FPL: 78%
-300-350% FPL: 72%
-350-400% FPL: 70%

The premium and cost-sharing credits will have limited availability to US citizens and lawfully residing immigrants who meet the income limits and are not enrolled in qualified or employer-based or individual coverage, Medicare, Medicaid, TRICARE, or VA coverage. Individuals who have access to employer-based coverage are eligible for the premium and cost-sharing credits if the cost of the employee premium exceeds 11% of the individual’s income.

Information cited from:
Kaiser Family Foundation (October 15, 2009). Health Care Reform Proposals. Retrieved from http://www.kff.org/healthreform/upload/healthreform_tri_full.pdf.

Tina Wederski