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Health Care Reform:

Health Insurance & Affordable Care Act

For Some, Affordable Care Act Costs Still Out of Reach

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That’s because the share someone must contribute toward coverage rises with their income, starting at 2 percent for those earning the least and rising to a maximum of 9.5 percent for those earning as much as 400 percent of the poverty level, or up to $78,000 for a family of three.

 “I live paycheck to paycheck,” La Voie said. “It’s not like I take vacations, go out to eat, or buy lots of clothes ... My money goes to rent, gasoline, food, student loans and utility bills almost exclusively. Believe me, there's not much left over for extras. It's very depressing.”

While lower-income people face the same pressure, they will get more help from the government. More than half of the uninsured, for instance, are poor enough to qualify for free or low-cost care through Medicaid, if their states expand the program under the law.  Others will qualify for the most generous subsidies to buy private insurance.

When Joan Fiander of Annandale, Virginia, checked what might be available for a close relative making $9.50 an hour and working full-time, for instance, she was gratified to discover the family member would qualify for subsidies that would keep her monthly insurance cost below $50 a month.

“She was very excited, very excited,” Fiander said. “This is the first time in a long time that she’s gotten a break.”

The law also provides lower-income consumers reduced payments for deductibles and copayments for doctor visits or hospital care. But that help ends after household income hits 250 percent of the poverty level. 

After that level, the law caps out-of-pocket payments to a maximum of $6,350 annually for an individual, or $12,700 for a family.

Insurers must provide certain preventive care services for free, such as cancer screenings and some vaccines. And some plans may also offer doctor visits or other services for a small payment without triggering the deductible. But visits to specialists, buying prescription drugs and hospital stays are among the medical services likely to cost more in the form of copayments and deductibles.

Tue, Sep 24 2013

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