Understanding a new kind of financial assistance. Jessica Dunbar, Individual Market Manager

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1 Understanding a new kind f financial assistance Jessica Dunbar, Individual Market Manager

2 Financial Assistance thrugh Cnnect fr Health Clrad-Agenda Overview f regulatins and streamlining eligibility fr insurance affrdability prgrams Wh is eligible fr tax credits? Wh is eligible fr cst sharing reductins? Hw is mdified adjusted grss incme calculated? Case studies Shpping experience n Cnnect fr Health Clrad What t cmmunicate t cnsumers 2

3 Visin fr expanding cverage thrugh streamlined and expanded financial assistance Under the Affrdable Care Act (ACA) there is nw a new cntinuum f insurance affrdability prgrams: Expanded Medicaid Child Health Plan Plus (CHP+) Advanced Premium Tax Credits (APTC) and Cst Sharing Reductins (CSR) that can be applied t Qualified Health Plans Eligibility fr these prgrams will be based n a new methdlgy that aligns with tax rules (i.e. MAGI r mdified adjusted grss incme) Financial assistance will be prcessed thrugh a cmmn applicatin 3

4 4

5 What are subsidies and hw will they be applied t plans? Advanced Premium Tax Credits--Financial help t reduce the cst f premiums Individual earning between $15,282 t $45,960/year Cuple earning between $20,628 t $62,040/year Family f fur earning $31,322 t $94,200/year Tax credit applied up-frnt by IRS The subsidy is based n the premium fr a Silver Level standardized plan (the secnd lwest cst silver plan available in the marketplace). An individual r family wh wants a mre expensive r higher tier plan (i.e., gld r platinum) must pay the difference. Cst Sharing Reductins--Financial help t reduce ut f pcket csts (c-pays and deductibles) Individuals earning $15,282 t $28,725/year Family f 4 earning $31,322 t $58,875/year 5

6 What frms f financial assistance can peple take advantage f n Cnnect fr Health Clrad? In Clrad Advanced Premium Tax Credits are exclusively available thrugh Cnnect fr Health Clrad. After cmpleting an applicatin n ur website peple will find ut what level f APTC and CSR they qualify fr and then prceed t shpping with plan prices adjusted accrdingly Peple can adjust the level f APTC dwn if they dn t want t take the maximum amunt r expect an incme increase during the cverage year Changes need t be reprted within 30 days t Cnnect fr Health Clrad If a tax husehld earns mre mney during the cverage year than what is declared in the applicatin and APTC is received, the husehld will we mney back t the IRS If a tax husehld earns less mney during the cverage year than what was declared in the applicatin and APTC is received, the husehld will get an additinal refund frm the IRS 6

7 Examples f Premium Tax Credits fr an Individual Incme Incme as Percent f Pverty Annual Incme Premium Cntributin as a Percent f Incme Example f Premium Tax Credit 138% $15, % $4, % $17, % $4, % $22, % $3, % $28, % $2, % $34, % $1, % $45, % $630 Nte: Based n an individual with premiums f $5,000 per year and 2013 federal pverty levels. 7

8 Examples f premium tax credits fr a family f fur Incme Incme as Percent f Pverty Annual Incme Premium Cntributin as a Percent f Incme Example f Premium Tax Credit 138% $32, % $11, % $35, % $11, % $47, % $9, % $58, % $7, % $70, % $5, % $94, % $3,550 Nte: Based n an family f fur with premiums f $12,500 per year and 2013 federal pverty levels. 8

9 Example f Ptential Reductins* Bill is a 40-year-ld male making $34,470 per year Bill enters the marketplace thrugh the website and applies fr assistance paying fr his cverage. Bill qualifies fr $143 per mnth in premium reductin in APTC (300% FPL, 9.5% premium cntributin as a percent f incme) Bill shps fr and cmpares health plans with the same base benefits. Bill finds a plan that csts $417 per mnth. The tax credit brings his ttal cst t $274 per mnth. * Estimate nt based n actual prices 9

10 Example f Ptential Reductins* Jhn (40) yrs) and Jane (38 yrs) are married, filing jintly, with tw daughters ages 3 and 6. Jhn makes $40,000 per year and Jane makes $30,650 per year (300% FPL range, 9.5% incme premium cntributin) Jhn enters the marketplace thrugh the website and applies fr assistance paying fr cverage fr himself and his family. The family qualifies fr $482 per mnth in premium reductin (tax credit). Jhn shps fr and cmpares health plans with the same base benefits. Jhn finds a plan that csts $1,042 per mnth fr the family. The tax credit brings his ttal cst t $560 per mnth. * Estimate nt based n actual prices 10

11 Example f Ptential Reductins* Sam (50) yrs) and Laura (42 yrs) are married, filing jintly, with tw sns Trever (9 yrs) and Max (12 yrs) Sam is the sle incme earner in the husehld and makes $47,100 per year (200% FPL range, 6.3 % incme ges tward premium) Sam enters the marketplace thrugh the website and applies fr assistance paying fr cverage fr himself and his family. The parents are eligible fr APTC and qualify fr $794 per mnth in premium reductin (tax credit) and qualify fr CSR Sam shps fr and cmpares health plans with the same base benefits. Sam finds a plan that csts $1042 per mnth fr the family. The tax credit brings his ttal cst t $248 per mnth. Meanwhile, Trever and Max are eligible and enrlled in CHP+ and after the parents enrll in a plan n Cnnect fr Health CO, a link is presented t g t PEAK (state website) fr fllw up activities This family may want t find a carrier that participates in CHP+ * Estimate nt based n actual prices. CSR wuld als be applied t ut f pcket csts 11

12 Hw is mdified adjusted grss incme calculated? 12

13 Hw is mdified adjusted grss incme calculated? Based n the 1040 tax frm Incme add lines 7-22 Wages, salaries, tips, alimny received, capital gains, pensins, rental real estate, farm incme, scial security benefits, unemplyment benefits... Adjusted grss incme subtract deductins in lines Tuitin and fees, student lan interest, self emplyment deductins, health savings accunt deductins, mving expenses, alimny paid... Mdified adjusted grss incme add back in: Any freign earned incme excluded frm taxes Tax-exempt interest Tax-exempt scial security incme 13

14 Shpping paths available thrugh Cnnect fr Health Clrad If Medicaid/CHP+ eligible present ptin t link t PEAK t start applicatin 14

15 Incme calculatr n website Financial assistance calculatr nw available n ur website! Enter husehld size and incme fr all individuals included n yur tax return (yurself and spuse and dependents, if applicable). Enter age infrmatin nly fr thse husehld members wh need cverage. This interactive calculatr estimates hw much eligible individuals and families will spend n premiums fr an Exchange health plan under the law. The calculatr als indicates incmeeligibility fr Medicaid. 15

16 What t cmmunicate t the peple yu serve? Financial assistance available thrugh Cnnect fr Health CO culd save yu hundreds, if nt thusands f dllars thrughut the year! This financial assistance is available up frnt s yu can start seeing the savings right away Use the calculatr t see what yu may qualify fr Cnsider hw the acceptance f tax credits impacts yu and yur family at the end f the year; fr sme peple they may nt want t take the full amunt if they expect changes thrughut the cverage year Reprt any changes t Cnnect fr Health Clrad s we can make sure peple are getting the right level f assistance at any ne time 16

17 Thank yu! Jessica Dunbar Individual Market Manager Cnnect fr Health Clrad

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