Description:

Kaiser Family Foundation has created a calculator for subsidies and for premiums on the Exchange. So you just go to their website. There are a few things you need to enter.

So here's the calculator. The state we're using is actually going to be-- we're going to start with Massachusetts. We need to know the zip code, because exchange premiums vary with the area of the country. And even within the state, they can vary.

So we're in Massachusetts. Our zip is 02118. We're using 2014 for income. And I have a couple with an income of $65,000. They do not have employer coverage available. Because if they did, they actually couldn't get any assistance on the exchanges. There are two people in this family. In this family, two of the people are adults. Each adult is 58 years old, and neither of them smoke.

So it asks you this information for a reason. Part of the ACA is that premium varies by geography and they're set locally. Income matters for whether or not you get assistance, as does family size. And in some states, you actually can be charged more if you smoke. So here is my couple. And I'm going to hit Submit.

OK. So here it is going to tell me that my couple, their income is above 400% of the poverty line, at $419. So they will not qualify for any coverage. So they are not going to have any income max that they can't pay more than, because $400 is the cutoff. Their premium for a Silver plan-- this entire calculator is based on a Silver plan-- is $10,575 a year. They will get zero assistance. So they will not get tax credit. They will not get subsidy. They will pay the full $10,575 a year. And out of pocket cost wise, they will not have to spend more than $12,700 on deductible, copay and coinsurance. This $12,000 is after the premium.

So this is what we're going to look at. Massachusetts, if you have a 58-year-old couple, they make $65,000 a year, they don't smoke-- I'm not having anyone smoke here-- they are at 419% of the federal poverty level. So what that means is they are above $400, so the cost of their premium will be a $10,575, the cost of a Silver plan, that's what we're sticking to. They will get no help. They will pay the whole thing, which will be 16.3% of their income. And their out of pocket costs-- so this is beyond premium, we're talking deductible, coinsurance and co-pays will be a max of $12,000.

So what you can see is if this couple had a health catastrophe where they ended up spending up to their out-of-pocket max, they could potentially be liable for $23,000 in coverage. That is only, though, if they get up to their max. So often, you'll have a deductible and then your cost sharing in co-insurance, so it can take somebody a while to get up to the $12,700. Depends on the specific arrangements. But what they're definitely going to spend, even if they use no health care, is $10,575.

Now let's look at a younger couple. OK, this younger couple, what you notice is their premium's less. Because their premium is less, they are going to not spend as much money on it. So smaller percent of their income, but the out-of-pocket max remains the same.

Now let's look at a couple, so 35 and 58, these will be my ages for the rest of the time. This couple makes $60,000. So they are under 400% of the FPL. Because of that, they're eligible for assistance, because their premium cannot be over 9.5% of their income, no matter what state they live in. Same out-of-pocket max.

So this couple now makes $20,000. So they're making 29% of the poverty level. Or if they only make $14,000, they are going to get Medicaid. Because Massachusetts is expanding, so anyone below 133 is eligible for Medicaid. So that's the end of Massachusetts.

Now we're moving to Colorado. Colorado is a different geographic area. Premium costs can be different. But all the pieces about how much money you would have to spend are consistent across the country.

So this couple in Colorado, they make $65,000. They are above, for a couple, 400% of the federal poverty level. This means their premium, which is actually more expensive-- this zip code in Colorado is one of the most expensive in the country-- their premium is $11,000. They will get no help. They will pay for it all themselves. And the out-of-pocket max remains the same.

Now let's look at Colorado, a couple that makes $60,000. So they are under 400, so under the magic number. They are eligible for some help. And they actually are getting help. The premium's the same, because it's the same level of insurance. But they are only going to pay $5,700. If you look, that's the same they would pay in Massachusetts, because 9.5 is the max amount of income.

OK. Now if they're only making $20,000, they get Medicaid. If they're only getting 90-- sorry, that should actually be 14%. So I'm just going to fix that while we're here. If they're only making $14,000, which is 90% of the federal poverty level, they are actually going to get Medicaid, because Medicaid is expanding.

Now we're going to talk about Tennessee. So the couple, same ages, same income, they move to Tennessee. Same 387% of the poverty line. But look at their premium. If you look at this premium, it's $4,291. So same couple, had they lived in Colorado, they'd be paying $11,000 a year and getting help. Because they live in Tennessee, where they have some of the lowest premiums in the nation, they don't get any help, because they don't qualify. They're under 9.5% of their income, and so they can pay the entire premium themselves.

Now we're going to look at a couple where they're at 129% of the poverty level. And we looked at these same poverty levels above. In Massachusetts and in Colorado, this gets you Medicaid. Not in Tennessee. Tennessee's not expanding. So you're eligible for the same insurance as the people at 387%. The difference is, you are going to get $3,800 in help. You are only going to pay $400, which is 2% of your income. And your out-of-pocket max, if you look up here above, the out-of-pocket max dropped for these people. And that's because they're under 250%, and so their out-of-pocket max is less. So they have a lower premium than anywhere else in the country. They get some assistance. They have this out-of-pocket max.

Now we're going to talk about the last group. This is the last group in Tennessee. So the people who are making $20,000. Say now they're only making $14,000. They had a loss of income. So they're at 90%. 90% in other states gets you Medicaid, but not in Tennessee. Tennessee, you're on the Exchange, but you get no help. Because if you are under 100% of the federal poverty level in a non-expanding state, you do not get any assistance.

So when you think about it, the feasibility of a couple paying 30% of their income and having $9,700 left for the entire year, not so feasible. They also would have had a $12,700 cost sharing cap, because they get no assistance there.

Here is a link to the media file cryan_medicaid_w02_p02.mp4