Affordable coverage - Glossary (2024)

FAQs

What are the 4 levels of coverage offered under the Affordable Care Act? ›

There are four ACA metal tiers: bronze, silver, gold, and platinum. The law sorts the plans into different metal tiers according to their actuarial value (AV), or the percentage a health insurance plan will pay out of total costs for a specific benefit.

Employers must offer health insurance that is affordable and provides minimum value to 95% of their full-time employees and their children up to the end of the month in which they turn age 26, or be subject to penalties. This is known as the employer mandate.

Answer: Under the ACA, consumers who have pre-existing conditions can't be sold health coverage that excludes their pre-existing conditions. In addition, the law requires most health plans to cover certain preventive health services without cost sharing to consumers— including annual physicals.

For 2024, a plan is deemed affordable if its least expensive self-care option is less than 8.39% of a household's income. Furthermore, employers must demonstrate that their overall company plan would cover a “minimum value” of at least 60% of expected employee medical costs.

The Affordable Care Act's “shared responsibility” provisions (also referred to as the "employer mandate" or "play or pay") generally require that “applicable large employers” or ALEs (those with 50 or more full-time employees working at least 30 hours per week or their equivalents when adding together part-time hours) ...

The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and ...

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs. The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR.

The affordability threshold is the maximum amount that the employee's share of the premium can be. To calculate this, multiply the employee's household income by 8.39%. For example, if the employee's household income is $50,000, the affordability threshold would be $4,195 ($50,000 x 8.39%).

The 9.5% threshold for health insurance costs

This means that if you make $40K annually, the bill subsidizes health insurance premiums beyond just short of $4K.

The Affordable Care Act (ACA) is a comprehensive reform law, enacted in 2010, that increases health insurance coverage for the uninsured and implements reforms to the health insurance market. This includes many provisions that are consistent with AMA policy and holds the potential for a better health care system.

How much is Obamacare a month for a single person? ›

How much does the average person pay for Obamacare? Obamacare costs an average of $584 per month for a 40-year-old with a Silver plan. Your age affects your monthly rates. A 20-year-old pays an average of $443 per month for a Silver plan, while a 60-year-old pays an average of $1,240 per month, before subsidies.

In 2024, an individual in a one-person household is eligible for some degree of Covered California subsidies if they earn up to $33,975 Meanwhile, that limit rises to $69,375 for a household size of 4. These numbers refer to your Adjusted Gross Income (AGI) as found on line 11 of your Form 1040.

In 2024, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 8.39% of your household income. The lowest-cost plan must also meet the minimum value standard.

For a salaried employee, use the monthly salary as of the first date of the coverage period and multiply it by the appropriate affordability percentage for the year. Here's an example for 2024. Multiply the $2,000 monthly salary by the 8.39% affordability threshold for 2024.

The ACA set standards for “affordability,” but millions remain uninsured or underinsured due to high costs, even with subsidies potentially available. High deductibles and increases in consumer cost sharing have chipped away at the affordability of ACA-compliant plans.

4 different levels of coverage. -Bronze (60/40) -Silver (70/30) -Gold (80/20) -Platinum (90/10)

The law has 2 parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

On average, Platinum-level plans cover 90 percent of health care costs, and you pay 10 percent; Gold plans cover 80 percent, while you pay 20 percent; Silver plans cover 70 percent, while you pay 30 percent; and Bronze plans cover 60 percent, while you pay 40 percent.