Wait – what was that? The idea that people who purchase these plans are expected to share in the costs? Yep, that’s right. However, if you make between 100% and 400% of the poverty level (which, in 2012, is $11,170 for a single person, $23,050 for a family of 4, and more in Alaska and Hawaii) then you are eligible for reductions in cost-sharing, according to section 1402. This reduction varies by precisely how much your income is, but ranges between 1/3rd and 2/3rd .
Cost-sharing, in case you didn’t know, is the co-pay and coinsurance amounts that you often have to pay for health insurance. For example, in my health plan, I pay $25 to see a doctor, and 15% of any procedure performed. These would be my cost-sharing portions. If my household income is less than 400% of the poverty level, then those amounts would be reduced.
There are a couple of special provisions – pediatric dentistry is apparently exempted. In general, if the dental and vision plans are stand-alone, and not bundled with the health insurance, then they are not subject to any requirement of the PPACA. And if a person can be defined as an Indian (language that of the Act, not mine), and has income less than 300% of poverty line, then cost-sharing is eliminated altogether. If you are Not Lawfully Present, then you don’t get cost-sharing reduction. That means no cost-sharing reduction for undocumented peoples.
The next section is a shift in topic, to thinking about eligibility, so we’ll save that as your Friday Fun!