Obamacare shopping is trickier than ever

KINGMAN – Health care is complicated and time is running out with a Dec. 15 deadline looming. Shopping for an individual health plan just got even more so, with President Donald Trump’s decision last month to block $7 billion in Affordable Care Act subsidies.

Known as cost-sharing reduction payments (CSRs), these federal funds had helped insurers offset the costs of the discounts they are required to offer to some lower-earning customers to help them pay for deductibles and copays.

Experts’ advice, in brief, is: shop around. Play with different options on healthcare.gov or state marketplaces. You may be able to use the following guidelines to help determine the best deal:

Option #1

Your household income is $12,060 to $30,150 for an individual, $16,240 to $40,600 for a couple and $24,600 to $61,500 for a family of four.

By law, insurers still must pass along the cost-sharing reductions, even though the president cut off the reimbursement. And you are probably eligible for them.

To qualify for the cost-sharing reductions, which lower deductibles and copays, you must purchase a silver plan on the marketplace. Those buying other levels – the more comprehensive gold or platinum plans or less generous bronze plan –cannot get this benefit.

Option #2

Your household income is between $30,150 and $48,240 for individuals, $40,600 and $64,960 for a couple and $61,500 and $98,400 for a family of four.

You’re eligible for subsidies to reduce premiums, but not the cost-sharing reductions. Even so, the decision to cut them may affect you – in a good way.

The level of premium subsidy you receive is based not just on your income but also on silver plan prices, and now silver premiums are going up a lot. The higher the silver premiums, the more generous the subsidies.

Option #3

Your household income is more than $48,240 for individuals, $64,960 for a couple and $98,400 for a family of four.

If this is you, you’re ineligible for any Obamacare subsidies. That means your chances of getting slammed by premium increases for 2018 are high. Silver plan premiums can climb by 35 percent or more because of high claims and the end of cost-sharing reimbursement to insurers.

Option #4

Your household income is less than $16,643 for an individual, $22,411 for a couple and $33,948 for a family of four. You may qualify for Medicaid, the federal and state programs.

Editor’s note: Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.