Shopping For Health Insurance – The New York Times


There are also ways to lower the bill, through tax credits. Consumers whose estimated income in 2021 will be between the federal poverty level ($12,760 per year for individuals and $26,200 for a family of four) and four times that amount ($51,040 for individuals or $104,800 for a family of four) will be eligible for tax credits to subsidize coverage.

If your income is likely to be below the poverty level and you live in one of the 13 states that has not expanded Medicaid, coverage will be tricky. You may fall into the “Medicaid gap.” “That’s when you’re too poor for marketplace subsidies and too well-off for Medicaid,” said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.

In Alabama, for instance, roughly 134,000 people could fall into this gap, according to KFF.

One of the reasons that marketplace premiums remained the same or dropped in 32 states is that health insurers had record profits this year, said Sara R. Collins, vice president for health care coverage and access at the Commonwealth Fund, a private foundation that supports health care research.

Rates vary by the state, insurer and the metal level (bronze, silver, gold and platinum). Bronze plans usually have the lowest premiums but deductibles and co-payments will be higher. Gold and platinum plans may have higher premiums but lower out-of-pocket costs.

Once on the site, the marketplace will calculate your tax credit, which is based on the benchmark plan in your region, said Louise Norris, who has run a health insurance brokerage in Colorado since 2003 and writes about the topic for and Verywell. (H.H.S. designates the benchmark plan as the second-lowest-cost silver plan in your region). If you qualify for a tax credit, the exchange will apply it to any of the plans named for metals (but not “catastrophic” plans aimed at healthy young people). Credits for out-of-pocket costs also are included but only on silver plans and only if you’re eligible.

Using KFF’s Health Insurance Calculator, a hypothetical nonsmoker, age 55, earning $40,000 next year would pay $786 per month for a silver plan but would be eligible for a tax credit worth $458 per month, making the monthly costs for that plan only $328. “Every month, the I.R.S. would send that tax credit to the consumer’s health insurer, meaning he or she would pay only $328 each month and account for it on his or her tax return at year end,” Ms. Norris explained.

In October, H.H.S. reported that 22 new health insurers were offering coverage for 2021, bringing the total number to 181. Also, the average monthly payment for the benchmark plan dropped by two percent for 2021 when compared with this year’s rate, the third consecutive year that average premiums have dropped since the A.C.A. went into effect, according to KFF data.



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