The Advance Premium Tax Credit is a Federal Tax Credit for individuals that reduces the amount that they pay monthly for their health insurance premiums when they buy their health insurance on the marketplace.
The Advanced Premium Tax Credit is calculated by the federal government and sent directly to the health insurance carrier. The individual gets a monthly discount on the premium they pay each month.
Anyone eligible for this tax credit is determined by income. Those who make more will receive a smaller credit and smaller discount, while those with a lower income will receive a larger discount and larger credit. Because this tax credit is a direct payment the individual is not responsible for the entire amount, only the discounted amount.
All health insurance plans share some common characteristics. The Affordable Care Act also known as Obamacare requires that all health insurance plans offered in the individual and small group markets must provide a comprehensive package of items and services. These are known as the Essential Health Benefits.
These benefits fit into the following 10 categories:
To make the best health insurance choice for you and your family, you can't just look at the premium. Usually a lower premium means a higher deductible and a higher premium means a lower deductible.
The main choice is do you want to pay less per month for your premium but then risk having higher costs when you use your services or do you want to pay a little bit more per month and then pay less when you need to use your services?
Some plans also have separate deductibles, one for medical services and one for prescriptions. Some plans have co-insurance some plants have co-payments. Co-insurance is where you're responsible for a set percentage of the services received, a co-payment is when you have a set dollar amount for the services received.
Don't just assume the deductibles and co-payments are the only differences between the plans we really need to dive into it to see which services are available and covered. Be sure to check that the plan covers the prescription drugs that you take and at what cost. If you have a doctor that you would like to keep seeing make sure that they're a provider for that network, if they're not you're going to end up paying a lot more.
A deductible is the amount that you have to pay for your health care each year before your insurance starts paying for your care. Similar to car insurance, many health plans require you pay a certain amount out-of-pocket before the coverage kicks in. For example, if you have a deductible of $1500 you have to pay the first $1500 of your medical costs before your insurance starts paying. In some plans the deductible applies only to services that you get outside of the provider network. Also, some plans have a separate deductible for prescription medications. Usual deductible does not apply for preventive services.
An Out-Of-Pocket Limit is the most that you're going to have to pay each year for care covered by your plan. Once you hit that limit your insurance starts paying for all of your covered costs. Now if you have other family members on the same plan they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met as well. Some things that are not counted towards the out-of-pocket limit those can include your premiums, balance billing charges, and health care that the plan does not cover.
The money that you pay out-of-pocket for the services that you receive. This could include anything from an office visit to the doctor, prescription medicine, an x-ray, or even a hospital stay.
Now if the money you pay is a set amount that would be called a co-payment or a copay. If the money that you pay is a percentage of the cost then that would be called coinsurance. Now depending on the plan that you have it dictates whether you have a co-payment/copay or coinsurance.
Health insurance is divided into four main categories. Each category has the name of a metal, the more expensive the metal the more expensive the premium but the richer the benefits. Bronze for example covers 60% of your medical expenses it is also the least expensive premium. Silver covers 70%, Gold covers 80% and Platinum, the most expensive tier, covers 90%.
A health insurance premium is the amount of money you pay per month to the health insurance carrier. Now, you either pay by the month of you pay it per pay period depending if you get it through your employer or not.
If you get it through your employer, your employer most likely covers a portion of your premium.
If you get your insurance through either Covered California or through the exchange in another state then you most likely get an Advance Premium Tax Credit, that's where the Federal Government pays a part of your health insurance premium for you.
If you are not on the exchange and you buy directly through the carrier then you're paying 100% of the premium yourself.
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