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Premium subsidies in the Marketplace

Posted October 02, 2013 in Advice Column, Johnston

The open enrollment period for The Marketplace (Exchange) opened Oct. 1 and a question I get all the time is “I hear there are subsidies… How do I know if I qualify?”

Subsidies are possible for those households within 400 percent of The Federal Poverty Level. The levels are estimates as different federal departments seem to calculate  FPL differently. That said, here are the numbers for the maximum income per family to still receive a premium credit from Up to $45,960 for individuals, up to $62,040 for a family of 2, up to $78,120 for a family of 3, up to $94,200 for a family of 4, up to $110,280 for a family of 5, up to $126,360 for a family of 6, up to $142,440 for a family of 7, up to $158,520 for a family of 8. This is an estimate. Take your family income from 2012 and utilize The Kaiser Family Foundation calculator that can be found at This calculator finds subsidy estimates based on family income and make up.

Other factors to consider regarding the new healthcare plans
•    There will be no pre-existing — meaning no underwriting on healthcare plans written with an effective date of Jan. 1, 2014 and after.

•    In Iowa, we have a 5:1 ratio for 64-year-old standard rate compared to 21-yearold standard rate. Beginning Jan. 1, 2014 this ratio will squeeze down to 3:1. For most young and middle-age individuals there will be increases and possible small decreases for those closer to Medicare eligibility age.

•    There will be 13 essential benefits that will be required to be in all plans. This means all plans will have maternity and mental health and substance abuse coverage along with 11 other required benefits.

To assist with understanding the new plans, there will be a website — — for self-enrollment, navigators that consumers can talk to via phone or “live chat” and also qualified local agents who will be versed in the Marketplace and the subsidies to assist the public. Finding the assistance with the valuation of subsidy and the best coverage is important. Make sure you get all your questions answered.

Information provided by Janis Van Ahn, Health Insurance Advisor LLC, 5335 Merle Hay Road, Suite 2, Johnston, 515-225-9994,

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