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How the Afforable Care Act (ACA) May Lower Your Total Medical Expenses – only with a Silver Plan

After you have completed a Health Insurance application and provide household income information, you will find out if you qualify for a Premium Tax Credit subsidy that lowers your monthly health insurance bill.

 

You will also find out if, in addition, your income qualifies you for Cost-Sharing-Reductions (CSR). If you qualify, you can save money a second way: By paying less out of your own pocket each time you secure medical services. This can significantly reduce your total health care costs for the year.

 

IMPORTANT: If you qualify for these extra savings on out-of-pocket costs, you get them only if you enroll in a plan in the Silver category. There are four different metal catagories: Platinum, Gold, Silver, and Bronze.  You may use a Premium Tax Credit for any plan in any metal category, but you will get CSR only if you enroll in a Silver plan.

 

HOW YOU WILL SAVE ON OUT-OF-POCKET COSTS

  • You will have a lower deductible. This means the insurance plan starts to pay its share of your medical costs sooner. For example, if a particular Silver plan has a $6,100 deductible, you have to pay the first $6,100 of the Florida Blue medical charges yourself before the insurance company pays anything (other than co-pays and free preventative services). But if you qualify for CSR your deductible for a Silver plan could range from $0 to $4,300,

depending on your income.

  • You will have both lower copayments and coinsurance. These are the payments you make each time you secure care: like $65 for a doctor visit. If a silver plan’s co-pay is $65 for a doctor’s visit, if you enroll in a qualified Silver plan and you qualify for the CSR you may pay as little as $1 for your primary care doctors visit.
  • You will have a lower “out-of-pocket maximum.” This is the absolute amount that you would be liable for in a calendar year. For example, if you used a lot of care, because you became seriously ill or had an accident, your absolute maximum could be significantly lower. Instead of being as much as $6,850, your out-of-pocket maximum for a particular Silver plan, if you qualify for CSR, could be as little as $950.

 

IMPORTANT: Plans in all categories have a wide range of deductibles, co-pays/coinsurance, and out-of-pocket maximums. You will know exactly how much you can save on out-of-pocket costs only when you contact your local insurance agency and schedule an appointment with a health insurance agent. THE SERVICES PROVIDED BY YOUR LOCAL INSURANCE AGENT WILL ALWAYS BE OF NO COST TO YOU.