How much Obamacare costs you depends on five factors: your age, income, family size, location, and the type of plan you choose. The Affordable Care Act provides subsidies for middle-income individuals, families, and small businesses. It also expands free Medicaid for low-income households. It taxes higher-income families and businesses that don't provide health benefits.
First, your cost depends on the plan category you choose. All health insurance plans fall into one of four categories. They all offer the same 10 essential health benefits. The four categories are:
- Bronze - Has the lowest premiums, but only pays 60% of your health care costs. Pick this plan if you don't expect a lot of medical bills.
- Silver - Pays 70% of your covered medical costs, but the premiums are higher than the Bronze plan.
- Gold - Pays 80% of your costs, with higher premiums than the Silver plan.
- Platinum - Pays 90% of your costs, but has the highest monthly premiums. It will make sense to pick this plan if you have a chronic health condition.
The plans in each category allow you to compare monthly premiums, deductibles, copays, and annual out-of-pocket maximums. That's where it gets tricky. Even within the same category, the plan with the lowest premium may have the highest deductible. You might end up paying more for health costs if you get sick than you would with a plan with a higher premium but lower deductible. So you've got to estimate how much actual health care costs will be, then determine the insurance plan that helps you cut the total cost the most.
Second, your costs depend on your age. Health insurance companies are allowed to charge higher premiums for older people. But they can't charge more than three times the premium for younger people.
Third, is where you live. The cost of living, including healthcare, is higher in some cities than in others.
Fourth and fifth are your income and family size. If you make 400% or less of the federal poverty level, you will receive a subsidy. Here's how the subsidy works. Say you are a single person and you earn $47,520 (nearly 400% of the poverty level). Obamacare promises you won't pay more than 9.78% of your income a year, or $4,647.46, for the second-lowest Silver plan. Your subsidy is the cost of the plan, minus $4,647.46. So if the plan is $5,000, your subsidy is $352.44.
What if you want a more expensive plan? Obamacare bases all subsidies on the cost of the second-lowest Silver plan. So your subsidy is still $485 a year, which you can apply to any plan. You pay the difference.
Fortunately, healthcare.gov figures all this out for you. It lets you choose whether you want your subsidy each month, or the end of the year as a tax break. It even calculates the premium of the plan you choose based on your subsidy.
How Much Will Obamacare Cost Me If:
I Make Less Than $16,753 (or $34,638 for a Family of Four) - If your income is 138% or less of the federal poverty level, you qualify for expanded Medicaid. That means Obamacare costs you zero. But many states state didn't expand Medicaid. If you fall within this income range, and you can't get Medicaid from your state, here's what happens. First, you won't have to pay the tax for not having insurance. Second, if your income is so low that you don't pay taxes, you're exempt from the tax. Third, you can still apply for insurance on the exchange. You won't pay more than 2.06% of your income for a Silver Plan.
I Make Less Than $30,350 ($62,750 for a Family of Four) - If your income is under 250% of the poverty level, you pay no more than 8.29% of income for the Silver Plan. In other words, your subsidy is the cost of the second lowest Silver Plan minus 8.29% of your income. Use Healthcare.gov's subsidy calculator to find out how much.
I Make Less Than $48,560 ($100,400 for a Family of Four) - If your income is under 400% of the poverty level, you pay no more than 9.78% of income for the Silver Plan. In other words, your subsidy is the cost of the second lowest Silver Plan minus 9.78% of your income.
I'm Not Planning to or Didn't, Get Insurance - If you were without insurance for three months or more, you'll owe an extra income tax of 2.5% of your adjusted gross income when you pay your 2018 income taxes. It can't be less than a minimum flat tax of $695 per adult plus $347.50 per child, up to $2,085 per household. It can't be more than the cost of the Bronze plan. But the Trump administration directed the Internal Revenue Service to ignore this requirement and not assess the tax. The Tax Cut and Jobs Act repealed this tax effective 2019.
Even though you don't have to pay the tax, it's still a good idea to at least have catastrophic insurance. For example, the average emergency room visit is $1,389.
I Have Insurance - Your health insurance costs stay the same. But, you might get a better plan for lower costs from Obamacare. Keep in mind, too, that health insurance costs are rising regardless of Obamacare. Businesses have been putting more of the cost onto employees for years, just to keep their profit margins. Health care costs have been rising, on average, 3%-4% a year, so insurance companies are raising their fees to cover their profit margins. So if your health insurance costs have been rising, they will continue to do so for these reasons.
A vision care or discount dental plan, discount medical plan, or worker's comp is not insurance.
Catastrophic insurance is considered qualified insurance. But you may want to compare it to a full-coverage plan on the exchange to see if you can lower your overall health care costs. The only people eligible are under 30 or have some other circumstances.
The ACA improves Medicare costs. It reduced Part D costs if you fall into the "doughnut hole" gap in prescription drug coverage. By 2020, the doughnut hole will disappear.
If you have COBRA, you can keep it. But you will probably get a better deal on the exchanges.
I Make More than $200,000 ($250,000 for Married Couples) - Those making more than $200,000 a year ($250,000 for married couples filing jointly, $125,000 for married couples filing separately) pay these additional investment taxes:
- An additional 0.9% Medicare hospital tax on the income above the threshold.
- An extra 3.8% on the lesser of (a) investment income like dividends and capital gains or (b) adjusted gross income that is above the threshold.
- This tax applies if you sell your home and you make more than $250,000 (singles) or $500,000 (married couples) in capital gains. If you're selling investment property, you don't receive this exclusion. It all counts as capital gains.
I Deduct Medical Expenses - If you deduct your medical expenses that aren't covered by your health insurance, Obamacare initially cost you more. Until 2017, you could only deduct costs that exceeded 10% of your income. The Tax Cut and Jobs Act restored that level to 7.5% of income. In 2020, the level returns to 10%.
I Use a Flexible Health Savings Account - You could contribute $2,700 to your FSA in 2019, and up to $2,750 as of 2020. Over-the-counter drugs are no longer eligible FSA medical expenses. If you don't use FSA funds for medical expenses, the tax penalty increase to 20%.
I'm a Small Business Owner - If you have 25 employees or less, you receive a tax credit of up to 50% for your employees' premiums (35% for non-profit employers).
Those with 50 employees or less can use the exchange to find lower-cost insurance.
Those with 50 or more employees must provide affordable health insurance that provides minimum value or pay a tax of $2,000 per employee, for all but the first 30 employees. If a worker finds a lower-cost plan on the exchange, you may be taxed. That started in January 2015.
Businesses offering health insurance to early retirees ages 55-64 can get federal financial assistance.
I'm a Member of Congress or Staff - These individuals receive insurance through the Affordable Insurance Exchange, created through the ACA, and the federal government contributes the lesser of 72% of the program-wide weighted average of premiums in effect each year or 75% of the total premium for the particular plan an enrollee selects.
Obamacare Cost Calculator
- Cost of Obamacare depends on your age, income, family size, where you live, and choice of plan.
- Insurance in some states may be more expensive than in others.
- A family plan is more expensive than that covering an individual or a couple.
- The benchmark plan is the Silver plan offered in your area. The government determines your subsidy against this plan.
- Generally, younger and healthier people pay more under Obamacare. Older, less-healthy people pay less.
In Depth: True National Cost of Obamacare | Pros and Cons | What's Wrong With It? | Explain It to Your Kids | How to Get It | ACA Taxes | When It Starts | How It Works | The Truth About Obamacare