What your health insurance might look like under Obamacare

Posted Sept. 09, 2013, at 5:56 a.m.
Last modified Sept. 09, 2013, at 10:39 a.m.

What are your options under the Affordable Care Act? Here are some examples — with the help of some (slightly re-imagined) characters from “Grey’s Anatomy.”

Izzie, 24, single, no kids, doesn’t smoke. Lives with mom and dad in Bangor while she saves up money for medical school. She makes $16,000 a year working part-time for a modeling agency that doesn’t offer insurance.

The options:

— Because she’s under 26, Izzie can stay on her parents’ insurance.

— Because she’s under 30, Izzie can buy a low-cost, high-deductible catastrophic insurance plan. If purchased through the marketplace, it will cost her $184 a month with Maine Community Health Options or $209 a month with Anthem Blue Cross and Blue Shield. If Izzie takes up smoking, Anthem’s price will jump to $271 a month. (Should she move out of Penobscot County, those prices could change.)

— Because Izzie earns between 100 percent and 400 percent of the federal poverty level, she can get a subsidy from the federal government to help pay for her insurance. (However, it can’t be used for a catastrophic plan. If she wants a subsidy, she’ll have to buy a more comprehensive bronze, silver or gold-level plan from the marketplace.) The Kaiser Family Foundation’s online calculator puts her subsidy at $2,479 a year, or about 82 percent of her annual premium.

And, because Izzie earns less than 250 percent of the federal poverty level, she can also get a subsidy to lower her out-of-pocket expenses.

— She can go without insurance and pay the penalty. For a single woman, that will be $95 or 1 percent of her income, whichever is greater, for 2014. The penalty increases in future years.

Meredith, 39, and Derek, 41, married with two young children. The McDreamys live in Lewiston, work as doctors and make $200,000 a year between them. They get affordable family health insurance through their employer, one of the largest hospitals in the state.

Options:

— Meredith, Derek and their children can stay on the employer health plan. No change needed.

— They can ditch their employer coverage and buy insurance for themselves and their children through the exchange/marketplace. However, because their employer offers affordable insurance and because the family’s income is well above the poverty level, they won’t receive a subsidy.

— They can ditch their employer coverage and buy from an insurance agent. However, as with the exchange/marketplace, they’ll be responsible for the whole cost.

— They can go without insurance and pay the penalty. For 2014, that penalty will be 1 percent of family income or $95 per adult and $47.50 per child (up to $285 per family). The penalty increases in future years.

Preston, 70, single, no children. Lives in Portland. Currently on Medicare.

Options:

— Preston can stay on Medicare. No change needed. (The same is true for members of the military and those receiving Veterans Affairs health benefits.)

George, 30, single, no children, smokes. Lives in Farmington. Earns $10,500 as a freelance crossing guard.

Options:

— He can go without insurance. Because George lives in a state that didn’t expand Medicaid for the very poor, there is no penalty. However, he must apply through the marketplace in order to receive this exemption.

— George can buy insurance through the marketplace, but he won’t get help with it. His household income is less than the poverty level, which is too little for a federal subsidy to kick in. (He can also buy outside of the marketplace, but he won’t get help that way, either.)

— George may be eligible for a hardship exemption, allowing him to buy catastrophic coverage even though he’s 30 or older. Through the marketplace, that will cost him $209 a month from Maine Community Health Options or $280 a month from Anthem. If George quit smoking, Anthem’s price would drop to $216 a month. (Should he move out of Franklin County, those prices could change.)

Callie, 40, and Mark, 50, one child. They live in Oxford and have a household income of $60,000. The McSteamys can get family insurance through their employers, but it’s very expensive — they would each have to spend 10 percent of their income to pay for it, not including coverage for their young daughter.

Options:

— Callie and Mark can buy insurance for themselves and their child through the marketplace. Because they can’t get affordable coverage through their employer and because their income is just over 300 percent of the federal poverty level, they will get a subsidy to help pay for it. The Kaiser Family Foundation’s online calculator puts their subsidy at $2,223 a year, or about 28 percent of their annual premium.

And, because their household income is more than 250 percent of the federal poverty level, they cannot get help lowering their out-of-pocket expenses.

— They can go without insurance and pay the penalty. For 2014, that penalty will be 1 percent of family income or $95 per adult and $47.50 per child (up to $285 per family). The penalty increases in future years.

Walter, 38, and Joe, 39. Owners of a bar near Sabattus Grace Hospital where doctors and nurses unwind after their shifts. Walter and Joe already offer health insurance to their eight full-time employees.

Options:

— Walter and Joe have insured their workers since 2009. They can keep their current plan because it was in place before the law passed in March 2010, as long as the costs and benefits don’t change too much.

— Because they employ fewer than 50 workers, Walter and Joe could drop their plan without facing a penalty.

— Walter and Joe can shop for a new plan for their workers on Maine’s health insurance marketplace, through the business exchange called the Small Business Health Options Program (or SHOP Exchange).

They can apply for tax credits to help them afford that coverage, since the average wage they pay totals less than $50,000 and Walter and Joe contribute at least half the cost of their employees’ health insurance. The tax credit is already available, but next year it will expand to cover up to 50 percent of the employer’s contribution toward insurance premiums. Walter and Joe’s employees earn an average of $26,000 a year and the business pays $2,000 toward each worker’s premium every year. The National Federation of Independent Business’ tax credit calculator estimates their tax credit in 2014 at $7,680, or $960 per employee. Walter and Joe can take the tax credit for up to two years.

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