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Explaining Health Care Reform: Questions About Health Insurance Subsidies

Issue Brief
  1. Catastrophic health plans typically have a lower monthly premium than other Qualified Health Plans in the Marketplace, but generally require beneficiaries to pay all of their medical costs until the deductible is met. To qualify for a catastrophic plan, an individual must either be under 30 years of age or eligible for a “hardship exemption.”  For more information, see https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

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  2. These figures represent the FPL in the continental United States. The 2014 FPL is slightly higher in Hawaii ($13,420 for an individual and $27,430 for a family of four) and in Alaska ($14,580 for an individual and $29,820 for a family of four).

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  3. Lawfully present immigrants whose household income  is below 100% FPL and are not otherwise eligible for Medicaid are eligible for tax subsidies through the Marketplace if they meet all other eligibility requirements.

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  4. Employee contributions for family coverage may exceed 9.5% of household income and still be considered affordable under the ACA so long as the employee’s individual premium would not exceed 9.5% of household income.

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  5. With the exception of pregnant women in certain states, most lawful permanent residents must wait 5 years after receiving “qualified” immigrant status before being eligible for Medicaid.  For more information, see https://www.healthcare.gov/what-do-immigrant-families-need-to-know/

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