Q. Do you have any idea how the exchanges will administer changes throughout the year? Our current income is about $38,000 per year, which qualifies us for an enhanced silver plan. My husband often gets seasonal construction work and that can increase his income to about $65,000. When he reports that change in income, will he be required to stay in the enhanced silver plan and pay the full cost, or can he switch to a lower cost plan that he can afford?
A. From your description of your plan and your income, it sounds as if you and your husband currently qualify for both cost-sharing subsidies that are available to people with incomes up to 250 percent of the federal poverty level (currently $38,775 for a couple) and premium tax credits that are available to those who earn up to four times the poverty level ($62,040 for a couple). The premium tax credits lower the sticker price and can be applied to any of the four plan types. The cost-sharing subsidies can reduce marketplace plan deductibles, copays and total out-of-pocket costs, but are only available to people who buy silver-level plans.
If your husband’s income rises above 250 percent of the poverty level, however, you’d lose those cost-sharing subsidies and your out-of-pocket costs for copayments for doctors’ visits or for prescriptions, for instance, could be less affordable. Likewise, if your income reaches $65,000 you'd no longer qualify for premium tax credits. In that case, you might want to switch to a bronze plan with a lower premium, says Cheryl Fish-Parcham, private insurance program director at Families USA, a consumer advocacy group.
And you can do that. Under the health law, if your eligibility for cost-sharing subsidies changes, you have 60 days to switch from one marketplace plan to another. A similar though broader rule applies to eligibility for premium tax credits, enabling people to switch plans or enroll for the first time if they aren’t already on the exchange.
Please send comments or ideas for future topics for the Insuring Your Health column to email@example.com.