What will happen to Marketplace health insurance subsidy availability and size when the subsidy enhancements instituted under the American Rescue Plan sunset after 2025?| healthinsurance.org
Coinsurance refers to money that an individual is required to pay for services, after a deductible has been paid. Coinsurance is often specified by a percentage.| healthinsurance.org
An out-of-pocket maximum is a predetermined, limited amount of money that an individual must pay before an insurance company or (self-insured employer) will pay 100% of an individual's covered, in-network health care expenses.| healthinsurance.org
An off-exchange plan is a health insurance policy that is purchased directly from an insurance company or through an agent or broker, outside of the official ACA-created health insurance exchange.| healthinsurance.org
Under the Affordable Care Act, individual and small-group health plans that are not grandfathered must cover items and services in 10 health benefit categories.| healthinsurance.org
While the Affordable Care Act's premium subsidies help pay the cost of the health insurance itself, cost-sharing subsidies help to reduce out-of-pocket spending for eligible enrollees when they select Silver plans. The Trump administration eliminated federal funding for cost-sharing reductions, but the benefits are still available to eligible enrollees. And because the cost of cost-sharing reductions has been added to premiums, premium subsidies are much larger than they were prior to 2018.| healthinsurance.org
Federal penalties for being uninsured no longer apply since 2019, but some states are implementing their own coverage mandates. Find more info here.| healthinsurance.org
Under the Affordable Care Act, eligibility for Medicaid, premium subsidies, and cost-sharing reductions is based on modified adjusted gross income (MAGI). But the calculation for that is specific to the ACA – it's not the same as the MAGI that's used for other tax purposes| healthinsurance.org
The Affordable Care Act standardized individual health insurance policies by creating a “metal” ranking for individual/family and small-group policies, based on their actuarial value (the percentage of costs that the plan pays across a standard population).| healthinsurance.org
The ACA's subsidy cliff has been temporarily eliminated (through 2025), saving some health insurance buyers thousands of dollars per year.| healthinsurance.org
