A Look at Cost Sharing

Following is a brief example of cost-sharing reduction and savings for someone using a silver plan.

 

Standard Silver Plan

Cost Sharing Reduction

200-250% of federal poverty level

Share the plan pays

70%

73%

Deductible costs

$2,000

$1,750

Maximum out-of-pocket costs

$5,500

$4,000

Inpatient coinsurance costs

$1,500

$1,500

Doctor payment

$30

$30

 

The planner or an accountant can provide some methods for adjusting modified adjusted gross income (MAGI) to achieve a level of income that qualifies for subsidies. Leaving the workplace and entering retirement typically provides changes in MAGI, and it’s important to evaluate the impact of this transition with the Marketplace. Another consideration is that subsidies are based on projected income, so it is possible to work with your client in making adjustments throughout the year to hit the correct MAGI at tax filing time.

2. Marketplace plans provide inadequate or meager coverage. The truth is the Marketplace offers a variety of plans and options, many of which are quite robust. At a minimum, these plans must cover 10 essential benefits:

·      Prescriptions

·      Hospitalization

·      Lab services

·      Emergency services

·      Ambulatory care

·      Mental health and substance use services

·      Rehabilitative and habilitative services and devices

·      Preventive and wellness services

·      Maternity and newborn care

·      Pediatric services