Table of Contents
If you have an "affordable" health insurance plan now, chances are there are a lot of expenses that it does not cover. For instance, if you are a woman who is 57 years old and you buy the Blue Cross Blue Shield policy currently offered by the existing federal health insurance risk pool in Dallas, Texas, you pay a premium of "just" $400 per month.

However, you will have to pay the first $7500 of all your doctor and hospital expenses and the first $250 of your drug expenses each year, and the plan will only pay 60% to 80% of your covered expenses even after you pay $4800 in insurance premiums and $7750 in deductibles.
Many people simply can't afford the $1,000 per month per person some plans now cost. Fortunately, if you buy your health insurance through the new health insurance exchanges, low- and middle-income Americans will be entitled to Federal assistance with their premiums.
Americans will be entitled to assistance if they earn less than 400% of the Federal Poverty Level. In 2012, the Federal Poverty Level is an annual income of:
- $11,490 for a single person;
- $15,510 for a couple or a single person who has one dependent;
- $19,530 for a family of three;
- $23,550 for a family of four; and so on.
This means that you will qualify for a reduction in your health insurance premiums if:
- You are single and you have an income under $45,960 per year;
- You are a couple (or parent and child) and you have an income under $62,040 per year;
- You are a family of three and you have an income under $78,120 per year;
- You are a family of four and you have an income under $94,200 per year.
Starting next year, Americans who earn less than 133% of the Federal Poverty Level will be eligible for Medicaid. These low-income Americans will have an option of receiving direct Federal help for their bills as they incur them, or getting their health insurance premiums paid. However, if you qualify for Medicaid and you don't choose to get health insurance premium assistance, the government will only pay out as much money as would have been required to cover your premiums.
If you qualify for Medicaid, your health insurance premiums will be $0 per month. If you don't qualify for Medicaid but you earn less than 400% of the Federal Poverty Level, your premiums will probably be about half of what they are now.
How good is the new health insurance? For most people, there will still be a deductible of at least $1000 per year before the plan starts covering trips to the doctor (except for up to four routine checkups per person per year), and there will still be a co-pay of $10 to $30 for prescriptions. If you don't qualify for health insurance premium assistance or you don't qualify for full assistance with your premiums, you will be able to opt for a less expensive plan that has higher deductibles. Fortunately, for most people, the direct cost of healthcare is about to go down signficantly in just a few months.
- Leonard J, Rosenbaum S. Health insurance exchanges: implications for public health policy and practice. Public Health Rep. 2011 Jul-Aug. 126(4):597-600.
- Reisman M. Don't know much about health insurance exchanges: the next critical step: educating consumers and small businesses.P T. 2012 Aug
- 37(8): 452-63.
- Photo courtesy of sully_aka__wstera2 on Flickr: www.flickr.com/photos/sully_aka__wstera2/4468820992