Will I qualify for lower out-of-pocket costs under the Affordable Care Act?

When you purchase health insurance coverage through the exchange, you might be able to get lower costs on deductibles, copayments and other out-of-pocket expenses. It depends on your income and family size.

Qualifying for lower out-of-pocket costs in the exchange

When you purchase a qualified plan through the exchange, the amount you pay in out-of-pocket expenses for Essential Health Benefits is based on your income. It's on a sliding scale to keep it affordable for you.

Estimating Your Income

Use this 2013 information as a reference, even though the amounts are likely to be slightly higher in 2014. Also, amounts can be different based on family size, up to 8 family members.

* Up to $28,725 for individuals
* Up to $38,775 for a family of 2
* Up to $48,825 for a family of 3
* Up to $58,875 for a family of 4
* Up to $68,925 for a family of 5
* Up to $78,975 for a family of 6
* Up to $89,025 for a family of 7
* Up to $99,075 for a family of 8

The income amount for qualifying for lower premiums is different. Right now, we are just talking about qualifying for lower out-of-pocket costs when you use your plan for medical care.

For Silver Plans Only

The out-of-pocket savings can only be applied to Silver plans in the exchange if you qualify. 

Plans are divided into 4 different categories: Platinum, Gold, Silver, and Bronze. The categories are based on how much you pay toward medical costs and how much the insurance plan pays when you get medical care. It isn't based on quality.

When you qualify for lower out-of-pocket expenses, it's like getting a Gold or Platinum plan for the price of a Silver plan. You can select any plan you want, but you can only apply your out-of-pocket savings toward a Silver plan.