Major Medical Protection under Obamacare for 25 cents a day

Submitted by gsbaird on December 27, 2013 - 12:20pm

Young adults, based on recent polls, are unaware of the benefits they can obtain from the Health Insurance Marketplace, one of the major elements of the Affordable Care Act.

They dislike the individual mandate which requires that adults purchase a health insurance policy or pay a penalty. The principle of the mandate is that, to enable a few sick people to be in the insurance pool while holding premiums steady, a large number of healthy people need to join the pool.

Many view the mandate to be a violation of their individual liberties and, without looking any further into their options, have decided to pay the penalty when they file their 2014 tax returns. Here are some facts about the mandate.

1)    The penalty imposed by the mandate on those who earn low to moderate income is 25 cents per day in 2014.

2)    Any individual or family living in Texas with income of less than 138% of the Federal Poverty Level (FPL) is not subject to a penalty for not purchasing insurance. The table below shows the incomes below which no penalties must be paid.


3)    The penalty in 2014 is the greater of $95 per person ($47.50 for children) or 1% of family income. The next table shows the penalty versus family size and premium prices in Comal County for bronze and silver plans. Bronze plans are essentially catastrophic policies. Silver plans offer much lower deductibles and out-of-pocket limits versus the bronze plans but, as one might expect, the premiums are higher.

chart for affordable care act

Note 1: Bronze Plan: deductible = $5,000 individual, $12,700 family; maximum out-of-pocket (OOP) = $6250 individual, $12,700 family
Note 2: $0 deductible; maximum OOP = $500 individual, $1500 family
Note 3: deductible = $500 individual, $1500 family; maximum OOP = $1500 individual, $4500 family
Note 4: deductible = $2500 individual, $7500 family; maximum OOP = $5200 individual, $10.400 family
Note 5: The silver plan premiums shown are for the 2nd lowest cost silver plan in Comal County, are the same for anyone between the ages of 18 and 65 and do not vary based on pre-existing conditions. Premiums are higher for those who smoke.
This data was obtained from the Kaiser Family Foundation calculator. The link to the calculator is:

Photo courtesty of Simon Greig

The data in the table shows that families with moderate incomes can get catastrophic coverage at a cost that is lower than or no more than the penalty of 25 cents per day imposed by the individual mandate.

This coverage will protect families against serious financial setbacks that could result from an unexpected major injury or serious illness. The bronze plans include free yearly wellness checks from primary care physicians as well as other preventative care at no cost.

People who want more comprehensive coverage can obtain a silver plan at a very affordable cost.

From personal experience, I can say the website was a mess for the first two months after being introduced Oct. 1. However, since the beginning of December, enrollment has been easy to achieve within 1 and a half to 2 hours from setting up an account through applying for a subsidy and selecting a plan.

Those who are not well acquainted with health insurance or Obamacare, or who are not comfortable using a computer, can schedule a private counseling session with a Navigator associated with the Alamo Area Council of Governments by calling the Alamo Service Connection at 1-800-960-5201.