The Affordable Care Act Coverage Gap

HealthOne issue some Americans have with the Affordable Care Act (ACA) is the coverage gap- making too little to be eligible for subsidies and too much to be eligible for Medicaid. According to the Kaiser Family Foundation, more than 300,000 people are in this situation in North Carolina alone.

Although the federal government will pay most of the costs associated, there are 22 states that have chosen not to expand Medicare coverage, forgoing billions of dollars. There are even some individuals who have qualified for subsidies in 2014 but will have to refund them in 2015 because they made too little. Fortunately repayments will be capped at between $300 and $2500 depending on reported income and family size.

According to Bloomberg Businessweek, the subsidy caps apply to people who wind up making less than 400 percent of the federal poverty line, which (based on 2013 guidelines) would be at $45,960  for a one-person household or up to $94,200 for a four-person household. €

Although benefits expert Wise Skillman is headquartered in Jacksonville, Florida, he works with benefits in many different states.  “The biggest problem I foresee with the ACA is how much it truly cost the individual. Even with a subsidy, many of the individuals receiving these subsidies still will not be able to afford a health plan.  Even if one gets a health plan, most will not be able to afford the deductible if something happens to them. This is sad.”

Skillman explains that lack of health insurance knowledge is a large part of the problem.
“The biggest culprit here is that most of these individuals have never dealt with health insurance, thus, they don’t understand a lot of the terminology, etc.” says Skillman. “I find in my practice that it is usually more affordable for the individual to deal with a reputable agent and get a plan directly from a carrier. It is much more affordable, and having an agent dedicated to the individual helps the insured to be better informed about what they are really getting and how it will truly work.”

Zintro has experts in every industry sector, across every job function, in every geographic region. Recently, some of the following topics have seen inquiry activity: