However, Obamacare limits what people will pay out of pocket to $6,250 this year for individuals and $12,500 for families (including deductibles).
How are insurers complying with the essential benefit standards while limiting services or varying the cost sharing?
The lower a person’s or family’s income, the larger the subsidy.
A family of four with an income of $35,325 (150 percent of the current federal poverty level), who bought a $14,000 silver policy—one designed to cover 70 percent of someone’s medical expenses—would get an estimated subsidy of 83 percent of the premium cost. The subsidy for a family with an income of $47,100 (200 percent of the poverty level) would cover about 72 percent of the premium. The same size family with an income of $70,650 (300 percent of the poverty level) would get a subsidy covering about 44 percent of the premium. Families with incomes greater than $94,200 get no government help.
The exact amount of the subsidy will, of course, depend on the policy someone chooses and the family size. It will be calculated automatically at the time of enrollment in the state exchange.
Will subsidies be adequate to buy coverage with low cost-sharing for people whose incomes are in the middle range?
Where will consumers get help finding their way through the exchange jungle? The law provides for a system of “navigators” to help people sign up for coverage in the exchange, and also steer them to state Medicaid programs if they are eligible. Meanwhile, the Department of Health and Human Services set up another system, with “assisters” who will also give guidance. The assisters will be active later this year, during the initial open-enrollment period. (But note: Assisters will not be available in the 16 states where the federal government will exclusively run the exchange.) Another layer of helpers, called “certified application counselors,” will be available in some areas. They can work out of community health centers, hospitals, and consumer organizations.
How good is the counseling?